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We needed the investments being made to create a safe return to schools even before COVID struck – we need them now more than ever
The coronavirus pandemic has already shone a harsh light on our neglect of the elderly, homeless and growing racial and economic disparities.
Now the school system is about to get COVID tested.
When COVID hit in March, Ontario’s teachers were in a pitched battle with the province over smaller class sizes, mental health supports for children, adequate resources for kids with special needs and attention to crumbling school infrastructure.
Enter COVID-19 and it turns out we need all these things to deliver education safely.
In June, a Toronto District School Board survey of teachers found that 81 per cent were already concerned about students falling behind during the pandemic. Only 41 per cent of teachers said they felt comfortable returning to the workplace. In contrast, 73 per cent of students said they want to return to school and 66 per cent of families felt comfortable to send them.
Tola Ajao, a teacher at Parkdale Collegiate Institute says that “I always feel excitement and a bit of nervousness about going back to school, but this year it’s a sinking feeling.”
Ajao says that “I don’t have confidence that the provincial plan is organized and workable.”
The Ford government’s return-to-school plan has been criticized by Toronto Public Health (TPH) as well as infectious disease experts at SickKids Hospital, which has released its own guidelines for a safe return to school.
Robust testing continues and TPH has reported less than 10 cases per day on successive days this week.
With aggressive testing, contact tracing and isolation of infected people, this number could be falling even lower. It isn’t. And this may be an early warning that infections from Stage 3 reopening activities since July 30 are beginning to show.
It will take another two weeks to see the full effect. If numbers begin to increase, testing and tracing will have to be increased to ensure community spread doesn’t threaten school reopening.
In truth, the school environment will be safer for children than it is for teachers.
While research suggests that children overall do not become seriously ill with COVID-19, older teachers and administrators have a much higher risk of illness. Many teachers will also be placed in conditions that increase their vulnerability.
Masks, for example, have not been mandated for younger children. Even in the presence of enhanced cleaning some transmission will occur.
This is why teachers are saying that small class sizes of no more than 15 students are so important.
With a class size 15 students some distancing will occur naturally. The supervision of distancing will not be too onerous and teachers will have time to teach. Both teachers and students will benefit from smaller bubbles with lower exposure risks.
In Norway, Finland and Denmark, very small class sizes, and low community transmission rates allowed schools to reopen in late spring without outbreaks or a spike in community cases.
The TDSB’s projections indicate that class sizes of 15 for all elementary children up to grade 8 would cost up to $190 million depending on the model used. The province has allocated $30 million for additional teachers.
The provincial plan does envisage small cohorts for secondary schools. This will be essential as evidence mounts that older children are more like adults where transmission of COVID is concerned. The province is also spending money on personal protective equipment (PPE).
In addition, there is a need for effective testing and surveillance to protect teachers. The provincial plan allocates $23.6 million for testing, but there has been no discussion of how this is to occur.
In the provincial plan, symptomatic children and staff will be tested and isolated until results are available. This will prevent some infections.
But in younger groups, symptomatic individuals may represent the tip of the iceberg.
Surveillance testing could be offered to teachers in a systematic way.
In long term care homes, staff have been required to test every two weeks. This has been necessary to protect extremely vulnerable residents.
In schools, teachers could be offered testing as a method of self-protection. Opt-in testing, or even better systematic public health-led random sampling in secondary schools would allow us to stay ahead of the curve. Asymptomatic children could be offered a form of routine testing as well.
Saliva-based COVID-19 tests, with litmus paper style detection strips giving 15 minute turn around times for results, are currently in development. These are not as sensitive as the nose swabs. But they are much cheaper. And models suggest that with the fast turn around time they could be very effective preventing transmission.
Frequent testing could empower school communities with the knowledge that members are protecting one another successfully.
We should have leadership at the provincial level exploring and pushing for these tools.
But even if the province were to decisively support smaller class sizes, there are so many ways in which teachers will now be asked to do more.
The provincial plan calls for assessments and catch-up plans for students negatively affected by e-learning.
Teachers have also been asked to be vigilant about children who may have been exposed to maltreatment during school closure.
They have been asked to play a critical role in supporting children with pre-existing anxiety, depression, ADHD and substance use problems, all of which may have been exacerbated during the pandemic.
These same teachers are being asked to do all this with a day or two of additional training.
But infection prevention and control in schools should be coming from people who are trained to do it.
Local hospitals, community health centres, and public health authorities should be resourced to provide this support intensively.
Mental health supports should also be provided by those who are trained to deliver it – specifically school social workers and nurses. The Ford government has set aside funding for 500 school nurses for the province. But there are 583 schools in Toronto alone.
The investments made to create safe school communities in this time of COVID can strengthen the education system in the long run. We needed them before COVID, and we need them now more urgently than ever.
Suvendrini Lena is a neurologist and Assistant Professor of Neurology and Psychiatry at the University of Toronto. She holds a Masters in Public Health.