`THERE WILL BE CASES'
Delta surge spurs calls to cut COVID risks at schools
Earlier this week, Dr. David Fisman, an infectious diseases expert and epidemiology professor at the University of Toronto, shared some sobering numbers via social media: There's currently credible modelling in Ontario projecting a 70 per cent COVID attack rate in schools this fall.
Fisman, a member of the province's COVID-19 science advisory table, did the math using age-specific infection rates reported in a review of 13 jurisdictions in Europe and North America.
There are about two million children under age 12 in Ontario, which would mean 1.4 million infections, 1,316 with severe illness and 112 kids in critical care. In a population of 1.4 million children under 12, using the rates from the international study, seven would die.
“Whether or not you're comfortable with these numbers, at least they're real numbers we can discuss,” Fisman said. “For any one of us, the likelihood that that it will be our kid who is severely sickened or dies is very very low. But it will be someone's kid.”
On Friday, Fisman updated his comments, saying there have been enough cases of Delta variant in children between birth and the age of nine and enough pediatric hospitalizations in Ontario to say the odds ratio for hospitalization (a measure of association between an exposure and an outcome) has increased. It's too soon to assess the risk of being in the ICU or dying, he said.
Modelling is less of a prediction and more of a warning about schools and other places where unvaccinated people gather, said Ashleigh Tuite, an infectious disease epidemiologist and mathematical modeller at the University of Toronto.
The COVID -19 risk has not gone away, it has been shifted to another demographic group — young people, especially those under the age of 12 who don't qualify for vaccination, Tuite said.
“We have data suggesting Delta is associated with an increased risk of severe illness among those who are infected, so the estimated number of children experiencing severe or critical illness is likely underestimated. Now is not the time to strip away protective measures,” she said.
“We know there will be cases in school settings. We need to be proactive. Things like assemblies and choir practice I don't think are responsible right now until we have more vaccination in the population. High vaccination rates among adults will reduce the virus' ability to transmit in the community.”
Those who monitor the spread of infectious disease and treat children are urging caution, and are encouraging masking, cohorting, physical distancing and getting as many people vaccinated as possible.
But it's hard to say what schools will look like in the fall. It's unclear when vaccines will be approved for kids under 12 and the landscape changes by the day.
The London-Middlesex Health Unit announced Thursday that it would extend first Pfizer doses to 11-year-olds who turn 12 this year as of Friday, creating a social media stir. Then the health unit rescinded the announcement.
Asked about its plans, Ottawa Public Health said it follows Ministry of Health guidelines and only those 12 and older are eligible.
Ontario will allow students to participate in high contact sports such as basketball and hockey when the school year resumes, Education Minister Stephen Lecce said this week. Music programs, including singing and playing wind instruments, will be allowed in areas with adequate ventilation, such as outdoors or in a gym.
Earlier this month, Lecce said the province will not mandate vaccines for teachers or staff, saying the goal is to encourage vaccination on a voluntary level.
The Ontario Medical Association called for mandatory vaccinations for those working in schools this week, arguing that children are currently ineligible to receive vaccines and are reliant on others to keep them safe.
The new Delta variant is approaching the infectiousness of chickenpox, a disease that raced through elementary schools before there was a vaccine for it.
Like chickenpox, people have the impression that COVID-19 is a mild disease for children. But COVID is similar to chickenpox in that it can have long-term effects as well, said pediatrician Dr. Katharine Smart, the incoming president of the Canadian Medical Association. Some children with COVID-19 experience multisystem inflammatory syndrome, a serious condition in which organs become inflamed.
“Delta is new, but it's taking over. We have to be cautious when we go back to school,” Smart said. “Eighty per cent of people vaccinated isn't enough to keep COVID from ripping through pockets of the population. Now is not the time to let down our guard.”
Deaths are a “crude indicator” of the effect COVID will have on families and the pediatric system, she said, pointing out that children whose condition is critical will be have to treated in the ICUs of a small number of overstretched children's hospitals. Pediatricians are also bracing themselves for a surge of respiratory syncytial virus (RSV), which has been mostly absent during the pandemic. RSV is a leading cause of hospitalization for children.
“It adds to the risk of overwhelming the hospital system, particularly the pediatric system,” Smart said.
Smart warned parents not to be complacent after children are immunized. While vaccines prevent serious illness and hospitalizations, there is still the risk of a breakthrough infection or spreading COVID-19 to other people.
“The message is not `Don't go back to school.' It's `Be cautious,'” she said.
“It's too soon to stop the things we've been doing.”