Sick Kids’ COVID blueprint for a return to school challenges conventions

The report argues that the risk of COVID-19 to children is much lower than the harm to their mental and physical health if schools remain closed

Toronto’s best pediatric infectious disease experts at the Hospital For Sick Children have recommended returning to school in September. And they’ve provided a blueprint for how to do it.

Their report was released last month and updated this week. It states clearly that the risk of COVID-19 in children is much lower than the harm to their mental and physical health if schools remain closed.

The initial report was criticized for recommending that masks not be mandatory but made available for families and children who prefer them.

The updated report now begins with a clarion call to the province to make resources available to schools.

Specifically required are funds to screen students at school, the report says. And to address large class sizes, small classrooms and poor ventilation. But there isn’t much time.

Risks of COVID-19 lower among children

Sick Kids’ updated document says the decision to return to school should not be made for the sake of working parents or the economy.

Its review of the current literature found “strong evidence that the majority of children who become infected are either asymptomatic or have only mild symptoms.”

On the other hand, vulnerability to depression, trauma, addiction (and even suicide) are already taking their toll.

And while many parents of children with medical vulnerabilities will have special concerns, the report stresses that there is no evidence that COVID-19 is more dangerous than other respiratory viruses such as influenza for children.

Passing the screening test

Anyone who has been to a COVID assessment centre will know that the list of potential symptoms is long. They range from a runny nose to unexplained falls.

But keeping children who have any new symptoms home from school is a critical first step in making the return to school safe.

Parents and caregivers should screen children for COVID-19 symptoms prior to arrival at school, the report states.

The screening will facilitate early detection and treatment of any children and teachers who have COVID.

E-learning options will support children who stay home, but employers will need to enable parents to care for children.

But parents and educators should not make all health care decisions. Close collaboration with health care providers will be critical. A good solution would be to bring back school nurses, either in person or online to support parents with symptomatic children. The restoration of school nurses could have benefits that extend well beyond the present pandemic.

High on hand hygiene

COVID 19 is spread primarily through droplets in the respiratory system. Simple hand hygiene is the most effective way to interrupt transmission.

The report recommends scheduled hand hygiene occurring at least five times per day with access to sanitizers for each child and regular wiping down of commonly used areas.

Hand hygiene is important before and after meals, recess, physical education, sports, art, and music activities.

In short, children should be washing their hands as often as health care workers in hospitals.

Masks on, masks off

There is no consensus between experts on whether to mask kids.

They may be more useful for older kids. But masks need not be mandatory. 

The report points to evidence that increased contact between hands and mouths from fiddling with masks may in fact increase the risk of exposure to droplets.

The Sick Kids experts argue that masks may also interfere with learning. In particular, masks prevent the appreciation of non-verbal cues and facial expressions critical to developing social intelligence in children.

Physical distancing: less is more

The report encourages physical distancing measures but balances this with the importance of social interaction in child development.

Strict physical distancing could, the report says, cause significant psychological harm because playing and social interaction requiring closeness is so central to childhood development, particularly in elementary school.

The report does support smaller class sizes and spacing of desks to optimize the distance between students in classrooms, as well as the holding classes outside, weather permitting.

Parents may find Sick Kids’ statements about masks and physical distancing confusing or surprising. Why would these make sense when masks have been recommended for the general public anywhere indoors? And public spaces have been reorganized to emphasize physical distancing?

But the available studies suggest that children are not very infective.

A 9-year-old boy with respiratory symptoms was exposed to more than 80 classmates from three schools in France. None ended up being infected. 

In New South Wales, 9 students and 9 staff across 15 schools had close contact with a total of 735 students and 128 staff with only 2 secondary infections reported.

In Quebec, where schools opened despite moderate levels of community transmission, a few clusters developed. There have been larger outbreaks in schools in Israel, but those have been associated with crowded classrooms.

The report seeks a balance between safety and the fulfillment of the social and educational mission of schools. The Toronto District School Board has requested funding to keep class sizes to 15-20 students. So far, the province has not committed funds for these safer smaller classes. 

Overall, the Sick Kids report opts for simpler rules that do not provoke anxiety in children at every turn. It demonstrates what is possible if resources are available at the provincial level. This will only be safe, the report emphasizes, as long as community transmission rates remain low.

Families must continue to be vigilant about social and physical distancing and hand hygiene. And the province must maintain (even increase) funding for testing and contact tracing.

The health of children depends on it.

Suvendrini Lena is a neurologist and Assistant Professor of Neurology and Psychiatry at the University of Toronto. She holds a Masters in Public Health.


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