COVID-19 vs. school: We asked experts about transmission risks and what is needed to keep classrooms open
What school measures are working, what more is needed and how could new COVID-19 variants affect students?
After an extended break from in-class learning for thousands of students across Canada, the winter school term is officially on. But while many have returned to physical classrooms this week, most students in Ontario and some in Quebec are staying in remote-learning mode for now, due to what one official called a "troubling" rise in cases of COVID-19 among school-aged children.
We asked experts what the fall term taught us about coronavirus transmission in schools, how new variants of COVID-19 affect the risks of those transmissions and what measures are needed for in-person classrooms across Canada to open and stay open.
Here's what they said:
What's the risk of returning to in-person school now?
If students return to in-person classes now in areas where community spread is surging, there is a chance they could introduce the virus to peers and school staffers who they wouldn't come into contact with while learning remotely, an infectious disease physician explained.
The latest COVID-19 figures in Ontario — which has extended remote learning for students due to a spike in cases among school-aged kids this month — suggest what happened just before the holiday period was "a fair bit of mixing among families," said Dr. Nisha Thampi, medical director of infection prevention and control at CHEO, a pediatric health and research centre in Ottawa.
It's important to recognize that despite all the safety measures in place, schools are part of the communities where they are located, she said.
"Having children and youth return to school where the prevalence in the community is higher means that we're introducing potentially more risk into the schools and we're going to see more cohort dismissals and more disruptive learning," Thampi said.
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While relatively few students have developed severe coronavirus infections, "children don't live in isolation," said Thampi.
"They go back home," she said. "And the concern has always been about the transmission within the home [and] within the community to our vulnerable elders or people with pre-existing medical conditions."
What did we learn last term about school transmission?
During the fall term, health officials learned there's a higher risk of transmission among older kids and teens — closer to that experienced by adults — and a lower risk in younger children, said a virus expert.
But, while our understanding of coronavirus transmission in children and teens increased somewhat, there remains a lack of definitive data about the spread of coronavirus in Canadian schools, according to Jason Kindrachuk, assistant professor and Canada Research Chair in emerging viruses at Winnipeg's University of Manitoba.
That lack of data has "created a lot of questions in people's minds," said Kindrachuk, who has been seconded to the University of Saskatchewan's Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac) to help lead COVID-19 research efforts.
However, relatively few situations of ongoing transmission among Canadian students indicates school measures — such as physical distancing, smaller cohorts, masking and hand-washing — coupled with screening, testing and tracing have been part of an important, robust strategy that we need to maintain, said Thampi.
"Screening is not perfect because a significant number of children, youth and even adults can enter the environment with pre-symptomatic or asymptomatic COVID-19," she said. "So knowing that we can't completely eliminate the risk of bringing cases into the school environment, the next step is our mitigation measures or preventing the spread in the classroom."
Where we've fallen down, Thampi said, is in providing adequate support for families required to isolate when one person in a household tests positive for COVID-19.
Are measures like masking, physical distancing and cohorts enough?
Experts are divided on how effective current measures have been, but agree that additional action can be taken at higher levels to go beyond relying solely on individual students and educators.
Thampi said she has faith in the measures already identified, but she pointed out not all schools can implement them.
For instance, physical distancing works best if schools can separate students into smaller cohorts and classrooms. But not all schools are funded to have smaller classroom sizes, which would require hiring more teachers, so not all schools can implement those measures.
"So then it becomes a question about budget decisions," said Thampi.
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A public health educator in Quebec said the measures haven't gone far enough in her province, specifically regarding ventilation.
Roxane Borgès Da Silva, assistant professor of public health at the Université de Montréal, is among the 300 experts who signed an open letter urging government officials to update guidelines to address aerosol transmission of COVID-19 and calling for a host of ventilation improvements.
"Some schools — they are very old. You cannot open the windows and there is no air filtration system," notes Borgès Da Silva.
There needs to be concrete investments in improving ventilation in schools to have "all assets on our side" in minimizing coronavirus transmission in classrooms, she said.
How could new variants, now detected in Canada, affect our schools?
School officials must take into account the emergence of highly contagious new variants of COVID-19 — one first reported in the U.K. and another in South Africa — and remain stringent with school infection prevention and control measures, the experts said.
"We know that [the U.K. variant] is very contagious and we know also that children are a vector of this new variant," said Borgès Da Silva.
In fact, if it is confirmed to be present in Quebec, she said the province might have to consider "more strict measures," to prevent school transmissions.
While the severity of the disease from the U.K. variant appears to be the same as the COVID-19 strains currently circulating, "it's getting more people sick and it's going to inevitably put more people in the hospital," said Kindrachuk.
However, it doesn't appear to have "superpowers," against the usual measures, he said.
"Masking still works, distancing still works, hand hygiene, not being in the same spaces as others, all those things still apply," Kindrachuk said.
"We just need to be more stringent. And I think that is something we certainly have to address in schools."
Why haven't we seen more testing in schools?
Up to this point, testing has been limited so as not to overtax medical and lab resources.
But with new, more contagious variants surfacing, this is a good time to focus on getting specific coronavirus data from Canadian schools, according to Kindrachuk.
There have been advancements in the kinds of tests officials can access — for instance saliva testing, which can be easier for kids to tolerate than nasal swabs and conducive for taking repeated samplings, Kindrachuk said.
"We have to put the time in at this point and say let's address this specifically and not necessarily wait for others around the globe to do it first and tell us what they're seeing."
Thampi cautioned however about the need to consider the school disruptions that may arise from an increase in testing students.
"Right now, our response to identifying cases in the classroom or in the cohort is to dismiss the cohort," she pointed out.
"If the response is to shut down a school, it's very inequitable because we're not able to as rapidly provide the online supports that these families need and so you end up pulling back students, in terms of their education potential, because of what's happening in the community."
What must happen for schools to open and stay open across Canada?
Reopening all in-person schools successfully will likely require stricter government restrictions on gathering, coupled with other measures, the experts said. That's because although provincial officials have enacted a variety of lockdown measures, they haven't so far been able to fully prevent people from congregating and spreading the virus.
"Our government needs to act decisively and support businesses to effect a true lockdown that will last until we see a sustained decrease of COVID-19 rates in the region," Thampi said.
Secondly, governments must support public health units and education partners "to ensure that infection prevention and control measures, as well as a co-ordinated testing strategy, are in place in schools," she added.
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Kindrachuk feels several strategies can help preserve in-person schooling, beginning with looking at the many places still open where adults are able to congregate.
"We have to look at those and say: 'OK, now what are the last ditch things that we can do to try to cut transmission in that age group before we look at schools?'" he said.
He's also an advocate for introducing a co-ordinated COVID-19 testing strategy in schools — even tapping into research lab resources — and calls for a more universal approach to the preventative measures classrooms are using across Canada's different regions.
"There are limitations in terms of getting resources and budgets to be able to do some things — I certainly appreciate that. But we have to have a concerted approach," he said.
"What are the things that we know work?" he added.
"How can we standardize those so that from region to region, district to district, everybody knows what they're trying to do and has basically a common rule book that they can go through and say 'Yes, these are the things that we're doing correct. These are the things that we need to fix.'"
With files from Deana Sumanac-Johnson