White Coat, Black Art·THE DOSE

How can I send my kids back to school safely — for them and for us?

Pediatric infectious disease specialist Dr. Nisha Thampi talks to Dr. Brian Goldman about what parents should know about minimizing COVID-19 risk at school, and the role the community can play in keeping schools safe.

Pediatric infectious disease specialist Dr. Nisha Thampi talks to Dr. Brian Goldman

Wearing masks to prevent the spread of COVID-19, elementary school students walk to classes to begin their school day in Godley, Texas, Aug. 5. Pediatric infectious disease expert Dr. Nisha Thampi said there's a lot the community can do to contribute to a safe return to school. (LM Otero/Associated Press)

It will be a back-to-school season like none we've seen before.

When schools reopen in just a few weeks, it'll be for the first time back for most Canadian students since schools were shut in March to prevent the spread of COVID-19.

In some jurisdictions it'll be mandatory for students to wear masks. In others there will be whole new time tables in place. And for everyone there will be new protocols for hand washing and social distancing.

Yet parents still have so many unanswered questions about what school will look like and how we'll be able to keep our kids healthy while they're there.

As a pediatric infectious disease specialist and mother of two elementary school students, Dr. Nisha Thampi shares those concerns. 

But the medical director of infection prevention and control at Children's Hospital of Eastern Ontario (CHEO) in Ottawa, told Dr. Brian Goldman, host of CBC podcast The Dose, that families — and the broader community — can all play a part in keeping kids healthy and schools open this fall.

One simple way to start is by learning the hand-washing song Thampi wrote with her daughter. (Since the pandemic hit, it's been made available in 29 different languages.)

Here's part of Thampi's discussion with Goldman about a safe return to school.

You're not just an infectious diseases specialist, you're also a parent of two elementary school students. What are your biggest concerns around sending your own kids to school this fall?

So I want to see lower cases in our community. Jurisdictions that opened school with more cases of Covid in the community did not keep their schools open for long. We have very good evidence to show that children are most likely to get a COVID-19 infection in their home environment with an adult household member. So if adults are bringing the infection home, surely we'll start to see children coming to school with it.

We also need to have a robust isolation, testing and contact-tracing strategy to support the affected students and teachers and minimize the number of children who would be exposed to COVID-19 in the school. 

Thampi is medical director of infection protection and control at CHEO, and the mother of two kids in elementary school. (Hallie Cotnam/CBC)

What should parents be doing right now in the weeks before school to get their kids ready?

In terms of the child or the adolescent, get them used to the idea of wearing masks for settings where they may not be able to maintain physical distancing. In some jurisdictions, masking will be mandatory. So being able to get used to the fabric and the breathability of the mask and wearing it for prolonged periods of time — that's important to start now.

Another strategy for parents is to ensure that they are more thoughtful around activities in the community to minimize the risk of transmission, because we know that parents are likely to bring the infection home. 

What do you expect to see changed around the layout and physical environment of schools to help protect students and teachers and other staff from the coronavirus? 

So I think of infection prevention and control in schools kind of in two different ways. One is the elimination strategy. So you seek to minimize the number of people who are entering the school with COVID-19. And that's, as I mentioned, decreasing the community transmission, screening individuals who are symptomatic out of school, providing remote or virtual learning opportunities, and having a rapid-response plan such that kids or staff who are symptomatic are quickly isolated, tested, and then there's close follow up with public health for contact tracing.

Science teachers Ann Darby, left, and Rosa Herrera check-in students before a summer STEM camp at Wylie High School July 14 in Wylie, Texas. Thampi warns that daily temperature checks are not a reliable way of screening for COVID-19. (LM Otero/The Associated Press)

Once a person has entered the school, we want to minimize the number of people who are exposed to that [potentially asymptomatic person] in the school. And so this is very similar to what public health has been recommending for the community to decrease opportunities for close contact.

So that's ensuring good ventilation and outdoor education where possible, physical distancing of furniture so that we're not relying on individual behaviours to do the right thing, putting up physical barriers where the physical distancing cannot be provided, cohorting to minimize the number of students who would be exposed to a single case. And some people have talked about smaller pods within the cohorts to again further minimize the risk of exposure. 

Then there's also increasing education around personal hygiene at school as well as in the home. And I think schools can lead this piece, and that would be encouraging hand hygiene and respiratory etiquette.

What kind of screening should the school do before allowing a student or a teacher or another member of the staff to enter the school that day

We can draw from what we've seen in other sectors like acute care and long-term care with screening for the presence of symptoms. It's also what we want to be able to put in place, not just for COVID-19, but also for other respiratory or gastrointestinal viruses. Because wouldn't it be nice if schools were not breeding grounds for outbreaks and other kinds of infections?

Do you think there's value in taking the temperature of everybody who enters the school each day? 

I think taking the temperature can be problematic because it's not a very sensitive marker for COVID-19 infection, especially in kids.

What's the maximum number of students that should be permitted in a classroom where they're going to be in fairly close proximity? 

Ideally, we would want to have smaller class cohorts. And we've talked about the number fifteen because that, for most standard classrooms, would [allow for] keeping a two-metre distance between the desks.

But classrooms don't often function with desks facing the front, facing the teacher. For me, the ideal class cohort is something that our learning environment experts need to come up with and help give us direction.

There's high expectations from the community that the return to school would be a return to the pre-pandemic way of learning. We all have to be prepared that there are going to be bumps along the way. Introducing these safety measures is very important, but will surely take away from the time to learn.- Dr. Nisha Thampi

I think it's clear that pre-COVID-19, those class sizes were fairly large. It can be challenging for the educator to ensure that children are maintaining their physical distancing, that they're washing their hands. It can take many minutes to get elementary aged students to wash their hands and there's not often a sink in the classroom. So you may be supervising kids in the bathroom. But in addition to that, it can be hard to get them to keep their masks on to ensure that they're not self-contaminating with inappropriate touching of their masks. So from a logistical perspective, we would do well to advocate for smaller class sizes.

Sounds like a lot for an individual teacher to have to monitor through the course of a school day or even if it's half a day.

There's high expectations from the community that the return to school would be a return to the pre-pandemic way of learning. We all have to be prepared that there are going to be bumps along the way. Introducing these safety measures is very important, but will surely take away from the time to learn. 

One of the things we could also consider is a system to support teachers more, for instance, by having extra staff available to wipe down surfaces in class. Is that something you would expect to see? 

I would hope to see additional measures put in place to support teachers to be able to focus on the curriculum, whether it's additional housekeeping staff, additional monitors to support children in their hand washing behaviours, or to help ensure that masks are fitted correctly, to help support the medically fragile children who are in the classroom and ensure that they're kept in a safe space. 

And to be able to nudge children to keep their distance in such a way that still makes children feel like they're in a safe space, that they're not being punished for being close to their classmates, and to have as normalized an experience as possible.

A student has her hands sanitized in the schoolyard, as schools outside the greater Montreal region began to reopen their doors in Saint-Jean-sur-Richelieu, Quebec, May 11. (Christinne Muschi/Reuters)

There's been a lot of talk about holding classes outdoors in tents. What impact would that have on cases and transmission of the virus? 

Being outdoors seems to be associated with a lower risk of COVID-19 infection transmission. So it sounds like a great idea in the summertime to have classrooms outside in tents. What that looks like in the winter may have to be different, but we wouldn't be the first jurisdiction to have outdoor education in a colder climate.

Let's turn to teachers and school staff. How much do they risk their health by returning to work compared to students who are otherwise well, returning to school?

So I can appreciate teachers' concerns about going back into the classroom setting. We had health care professionals who were very concerned about patients coming in with COVID-19. However, where we saw health-care workers getting infection was in the break room. It was during lunch breaks, during snack breaks, when people took off their masks and were sitting in close proximity. And so I want to be careful that we not just focus on the student-teacher interaction, but that we also ensure that there are safety measures in the other areas of the school.

How young would you say is too young for children to wear a mask?

So masks are not recommended for children under the age of two years, as well as kids with developmentally complex conditions who are not able to take on and off their masks independently. 

Students in Taiwan sit at desks equipped with yellow dividers. (Ann Wang/Reuters)

Students tend to congregate a lot more during lunch and recess. How important is it to regulate contact outside the classroom during the school day?

The safest strategy would be eliminating lunch hours in a congregational setting. So either removing lunch hours altogether or having kids eat at home; that's not practical for kids who have to take a bus and who are not walking distance from home. Another approach would be to minimize the number of kids who are eating at the same time -- a staggered lunch hour. 

Barring that, other strategies that have been undertaken are having Plexiglas barriers set up between individuals at a table as an alternative to the two-metre distancing.

Recess is a different experience that's typically outdoors. And we know that with air circulation and good ventilation, there is a much lower risk of getting COVID-19 outdoors.

Children study at a school room where plexiglass dividers are installed on desks at Takanedai Daisan elementary school in Funabashi, east of Tokyo, July 16. (Kim Kyung-Hoon/Reuters)

Once schools reopen, should teachers and students isolate themselves from grandparents and other relatives at risk?

I think that's a really hard question because it may work one way for a family that has their grandparents living in a retirement home or in a different city. That's very different from multigenerational homes where there may be multiple individuals in the household and an inability to isolate. Also, it's not just the student who can bring the infection home. All the adults can bring the infection home, too. [Families should take] collective responsibility to be mindful about their activities outside the home and put in safety measures like physical distancing and masking and hand washing when they're out and cough etiquette when they're in the home. 

From everything that you've said, you're in favour of schools opening. If there are adequate precautions put in place, you see the importance of in-person education, albeit under safe circumstances. What would happen after the schools reopen that would make you think twice or even make you think about closing schools down?

So I'd be concerned about school transmission if we were seeing an uptick in our community transmission rates. But I would say that a priority should be keeping schools open. And so if we start to see more cases appear outside of schools, we should be prepared to walk back from stage three and ensure that other high-risk social settings are closed to minimize the risk of students and teachers acquiring the infection from the community and from adult household members and bringing the infection to school.


Written by Brandie Weikle. Produced by Jeff Goodes. Q&A edited for length and clarity.

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