09Jul
2020
Raywat   /    blog, COVID-19, education, epidemiology   /    1 comment

COVID19: How Do We Open Schools?

by Raywat Deonandan, PhD
Epidemiologist & Associate Professor
University of Ottawa
(I add my credentials to these COVID-19 blog posts in case they get shared. I want readers to know that my opinion is supposedly an educated and informed one)

The most common questions from journalists I’ve received in the past couple of weeks all concern either mask-wearing or school re-openings. I’ve tackled the mask thing in two previous posts here and here.

And yesterday, I tweeted this image of a playground near my parents’ house in Toronto, with the accompanying comment:

This unexpectedly set off a whole new round of questions about child safety, which lead unavoidably to conversations about how to safely deal with children in a school environment in the Fall.

This morning, the head of the Children’s Hospital of Eastern Ontario, Alex Munter, penned an article urging the province to open up schools in the Fall: “CHEO head urging full return to school in September.” Alex also offered some more enumerated thoughts via a Twitter thread.

The same time, the Ontario government is proposing a complicated strategy to maximize students’ presence in the classroom.

So I thought it was time to itemize my thoughts on the matter.

Now, I try hard in these posts not to overstep my expertise. I’m a population Epidemiologist, not an infectious disease expert or a dedicated disease modeler or a child psychologist. I was, however, the founding Epidemiologist for the Ontario Centre of Excellence for Child & Youth Mental Health, and have necessarily done some research on the matter. But I cannot state with definitive expert confidence anything having to do with long term risks associated with children’s lack of socialization or formal schooling; all of that is speculative on my part.

So, without further ado, here are my thoughts on re-opening schools in Ontario, presented in ten points:

1. What’s At Stake?

Obviously, we want to keep children safe from COVID-19. But while young people are less likely to get sick from the disease, some do, and some even die of it. More commonly, young people can be a vector for transmission to their family members. There’s an older woman in my own family circles who died of COVID after having been infected by her teenage granddaughter who showed no symptoms. So the threat is real.

On the other side of the argument, children need to be socialized and formally educated. The longer we delay that process, and the younger age that that experience is denied, the more long term psychological damage and intellectual stunting might take place. As was phrased so well by someone more eloquent than I, “schools are more than just places of learning.” Schools in the Western world are young people’s primary gateway to growth, actualization, self-knowledge, happiness, and any life beyond the simple act of existing.

Any re-opening of the economy must come with it accommodation for child care. Most working parents rely on schools to be responsible for their children during the working hours. Any discussion of opening business must, therefore, include discussion of opening schools.

 

2. Modes of transmission

We know now that fomite transmission (i.e., getting it from touching surfaces) is not that big of a thing when it comes to COVID-19. Fomites don’t constitute zero risk, but the risk is low enough that we don’t need to be paranoid about every potentially contaminated surface.

This means that we can focus on the major source of transmission, which is respiratory droplets and, limitedly, aerosol transmission. It’s important to remember that the virus isn’t floating around us all the time. It’s brought to us by people. So if we control access to other people, especially other people’s faces, we’re mostly golden.

The exception is how we deal with bathrooms, eating venues, and ventilation systems. Those will require special attention and resources to be maintained to the highest of hygienic standards.

 

3. Infrastructure and Resources

I’m of the opinion that we can buy our way out of much of this. A province like Ontario has the money. If not, then borrow. What’s more important than the education and future of our children? The enormous CERB payouts show that we can find the money when we need to.

Investment is needed to hire more teachers to reduce the student-teacher ratio. Lease more schools so classes can be physically bigger to accommodate distancing. Install handwashing stations liberally. Modernize bathrooms with individual stalls and no-touch features. Hire more staff to maintain distanced flow and clean surfaces in cafeterias. Buy modern filters for HVAC systems in schools that desperately need to be modernized anyway.

And buy masks and, more importantly, face shields/visors for all students and staff. Face shields provide greater inward protection than masks, are re-usable, easily cleaned, unlikely to be forgotten, more comfortable to wear, and allow for visual communication and lip reading.

 

4. A Little More About Face Shields/Visors

One of the more difficult messages to get across is that mask-wearing is a transmission mitigation exercise, not a self-protection one. Cloth coverings reduce the distance traveled by droplets sufficiently that when worn by thousands of people, the rate of new infections should drop significantly. For the general public, masks are not PPE (personal protective equipment).

But schools are a different matter. For children in a contained setting like a school, the goal isn’t necessarily to have them incrementally contribute to lesser community transmission through mask-wearing (though that is nice). The primary goal is to prevent the little tykes from taking their disease home to their grandparents.

That means some PPE is warranted for children. And I think that face visors are the best option for that goal. While still offering some outward mitigation of droplet spread, visors offer a lot more inward protection, particularly around the eyes.

I reserve the right to revise that recommendation as new evidence manifests!

 

5. Different Ages Require Different Approaches

Kids who are 16 or 17 are pretty much adults in many ways and should be able to shoulder much of the adult responsibility for personal care. So for older students (I will let the child psychologists define the appropriate age cut-off) working remotely is a great option, as well as being left alone to navigate their choices for self-protection.

Distanced desks with face shields can be an option for them. If they choose to work remotely, they are advanced enough to be able to satisfy their social development needs in other ways.

For younger students, however, the challenge is more palpable. The very young cannot be relied upon to wear masks, and I think it’s cruel to ask them to do so. Children enjoy being physically near one another, and it may be counterproductive to instill in them an early fear of being close to others. They also share bodily fluids and are always exposing their mucous membranes to various surfaces.

For this age group, I have no obvious solution. For them, focus on #10 below is paramount.

 

6. Don’t Make It Complicated

I’ve seen some creative plans involving staggered classroom usage —2 days one week, 3 days the next– which is well-intentioned and based on a rational desire to limit exposure.

The problem is that these schedules must sync with parents’ work schedules and they must also be easily understood and remembered. The public already has a hard time digesting the guidelines for social bubbles and mask-wearing. A new layer of complexity will not result in anything positive.

Similarly, if students are only in the classroom 2-3 days per week, as is presently being considered by the Ontario government, many parents will have to make daycare arrangements for the remaining days. So instead of a single cohort of students with consistent exposures and supervision, children would be exposed to multiple exposures with multiple points of disparate supervision.

Frankly, it’s a recipe for failure. Like Alex Munter, I believe that for young children (those who cannot remain at home alone), schools should remain open five days per week. We can have optimal state-run focus on their safety and exposures that way.

 

7. Experiment

Infectious disease doctor Dominik Mertz has been suggesting that now is the time to run some pilot projects on how to introduce children back into the community. And he’s right. The sun is shining (the virus hates UV light), the weather is great (the virus hates being outside), and the case count is low. So we should be carrying out some tests to see if we can in fact create child-friendly programs while we have safety nets in place.

 

8. Offer Options

I’d like to echo Alex Munter’s point, that for those parents who do not feel comfortable sending their children to school, but feel that they have the capacity and wherewithal to home-school, resources should be made available. Frankly, every child that is home-schooled during this emergency is one fewer potential transmission vector we have to deal with physically.

The kinds of resources vary, of course. But they necessarily include curriculum and internet connectivity support.

Some things are probably off the table for the time being. Gym class is not an environment that lends itself to infection control. However, swimming pools are largely safe, I think.

 

9. Have An Emergency Plan

What happens when an outbreak is identified? Individual schools and Boards must have emergency response plans that include tracing and quarantine. Is there a place in the building for interim isolation while public health is informed? Is there sufficient data capture to enable rapid contact tracing? What is the data threshold that will trigger a complete school closure? These are the details that must be worked out.

 

10. Keep Community Rates Low

If you want to give children long term protection against school shooters, do you wrap them in kevlar, put metal detectors at the doors, and install security guards in every classroom? That might help a little. But most thinking people agree that your best bet is to reduce gun violence and gun access in the greater community. That’s how you keep kids safe.

Similarly, to keep children safe from COVID-19, we could wrap them in PPE and regularly scrub all surfaces —and we probably should do some of that. But ultimately, the easiest and most impactful way of protecting them (and their families) is to remove COVID-19 from the community.

That’s why the best thing we can do in order to keep our schools and our businesses open is to make sure we are doing everything humanly possible to keep the incident daily case counts low. This means that everyone needs to continue to physically distance, wash their hands, and wear masks in public indoor spaces.

In Ontario today, the reproduction number is below one. The number of COVID-related hospitalizations is under 100. The number of new cases per day hovers around 150 and shows no signs of climbing. We’re doing it. We’re strangling the beast. With the new mask-wearing laws, I expect those trends to accelerate.

If we don’t let our foot up off its throat, we can keep this virus at bay. That’s what needs to happen if we want to open our schools and keep them open.

 

Bottom Line

I honestly don’t fully know why anyone would care what I think about anything. But to the extent that my opinion on this matters, I feel that it is imperative that public schools be open for children in Ontario in the Fall. I also feel that they should have regular full schedules, five days per week, and that money should be thrown at the school system to make it maximally safe for all involved, including the teachers and custodial staff.

But I reiterate: the best way to do so is to drive down the case count in the overall community.

 

 

UPDATE (July 28, 2020): Lots of work is being on this issue. Here are some recent resources that I have found particularly useful:

 

 

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