I’ve been working as a physician in COVID assessment centres and mobile testing units for the last five months. I’ve learned that we are going to need to live with COVID. I’ve learned that we can.
A fundamental part of living with COVID is restoring stability and structure for play, learning, and social development for our children. With just six weeks to go before Ontario schools re-open, the question on every parent’s – and teacher’s – mind is, ‘Can we go back to school? Is it safe?’”
These questions can feel overwhelming. But they need not be. The bottom line is that children, teachers and their families will be safest in schools if the transmission in our communities is kept low or absent.
What we need is clear leadership. And so far, it hasn’t been coming from the Ford government or Minister of Education Stephen Lecce.
They have proposed that individual schools create contingency plans for three scenarios: full return, a hybrid model of in-class and online learning and full e-learning. No school has the bandwidth to create three separate plans. Nor is it necessary.
The difference between Toronto and say, New York City or Phoenix, Arizona is one of public policy, health care infrastructure and human behaviour.
Continued testing, contact tracing and public vigilance will drive our numbers down towards zero.
The provincial government can decide to send children back to school fulltime in September and can ensure that policy, resources and public behaviours will make that safe – and even fun.
If schools are permitted to work on one plan between now and September they will be able to do it confidently and safely.
In the city of Toronto, our community transmission rates are approaching the necessary lows.
This past weekend daily cases dropped below 20 per day. The estimated reproductive rate for the virus (“R”) has fallen to 0.56 with a possible upper limit of 1.03. This means that two people must be infected to transmit the virus to one new person. The estimate of “R” is very reliable when testing is vigorous and accurately samples the whole population.
Ontario is still testing approximately 20,000 people per day. Sampling methods could still be improved, but Toronto Public Health reports that the majority of test results are returned within 48 hours and contacts are notified within 24 hours of results. The speed and vigour of this process make a difference. It is driving the case numbers down.
If we keep it up, the science suggests we can return children to school under very safe conditions.
A study from Geneva published in the peer-reviewed journal Pediatrics in late May surveyed all patients with COVID 19 in the city between March 10 and April 10. Of 4,310 cases, only 40 were among people less than 16 years of age.
The investigators studied the household contacts of each of these children and could not find evidence of child-to-child or child-to-adult transmission. This detailed study suggests that, even in the same household, children typically do not transmit the infection to each other.
In Denmark and Norway, children returned to school in the context of low community transmission rates – and no increase in infection rates in either schools or the larger community was seen.
In both these countries, schools were resourced to allow children to return with smaller class sizes and aggressive hand washing protocols. These parameters are similar to the Toronto District School Board “Option A” allowing for full return five days per week with smaller class sizes.
Collaboration with local health care partners and institutions could add immeasurably to safety. But local leadership will be key. School leaders must be given latitude to adapt to local school needs and schools must also be adequately resourced.
For example, a safe return to school will be harder in Toronto’s poorer communities where both classrooms and housing are in short supply. The risks of transmission are higher for poor communities and communities of colour in our city where households share rooms and bathrooms. Resource allocation to schools needs to address this pro-actively and preventatively.
Toronto’s political and health care leaders are creating the conditions needed for safety in September.
We’ve had great leadership in the City at the public health level over the last few months. Staying the course, these rates will drop even lower in the coming weeks.
Yet, with the explosion of disease across our border and traumas suffered in long-term care homes fresh in our minds, there is deep anxiety among parents regarding return to school.
We need to be determined about our public health and hygiene practices. We need to continue to test aggressively into the fall. We need education and health care sectors to partner and collaborate. And we need to support the most vulnerable.
We can do this.
Suvendrini Lena is a neurologist and Assistant Professor of Neurology and Psychiatry at the University of Toronto. She holds a Masters in Public Health.
