Close bars to open schools? Experts say it’s not that simple
Percentage of positive cases a guide, but many factors are in play, experts say
A new rise in coronavirus cases has fuelled worries that if the current trend continues in Quebec the province will face community transmission levels that are too high to safely open schools in the fall.
Dr. Horacio Arruda, the province’s top public health official, said on Friday that private gatherings — particularly house parties attended by younger people — were behind many of the new cases. Bars, scrutinized after several establishments reported cases among staff and patrons, are responsible for only five per cent of the new cases, Arruda said, and they will be allowed to stay open, for now.
“Things could evolve and then we will take the decision to do the right thing,” he said. “Will it be to close some (bars)? Will it be to close ones in Montreal or in all Quebec? That will depend on the situation.”
The increase in community transmission of the virus comes as education officials plan the return to school next month.
Epidemiologists and infectious disease specialists contacted by the Gazette said low community transmission and few hospitalizations — but not necessarily the blanket closure of bars — are a prerequisite to opening schools. But they stressed that the benefits of educating students in person would likely outweigh the dangers posed by the virus.
Officials with the World Health Organization (WHO) have warned against opening schools while the virus is still spreading through the community and have suggested that a five per cent positive test rate should be the threshold number to determine whether community transmission is too high for reopening.
If more than five per cent of those tested have the virus, it may indicate that officials are “only testing the sickest patients who seek medical attention, and (are) not casting a wide enough net to know how much of the virus is spreading,” according to Johns Hopkins University.
In Montreal, public health officials signalled last week that the proportion of positive tests grew to three per cent. But the five per cent number is not a strict requirement for reopening, according to experts who spoke to the Gazette. They said it depends on a government’s testing strategy and a variety of other factors.
Before Arruda on Friday shifted the blame toward house parties, bars had been cited for many of the new cases in Quebec. The hashtag “#schoolsbeforebars” began trending on Twitter. Some Twitter users argued that schools could not safely open if the virus was spreading in bars.
But the experts contacted by the Gazette said that while bars presented a challenge to public health officials, there is little at this point to suggest that they will prevent schools from opening.
“I think (bars are) an easy target and yes we have seen cases connected to bars,” said Dr. Matthew Oughton, an infectious disease specialist at the Jewish General Hospital.
“I think it’s also reasonable to expect that there are other sources of community spread beyond just bars, so we would be making a mistake if we targeted bars exclusively and expected that alone will reduce community transmission.”
Dr. Caroline Quach, an epidemiologist at the Université de Montréal, said she had never been in favour of bars being open because she sees them as the easiest place to transmit the virus. But she said bars need not close as long as the end goal — preventing COVID-19 hospitalizations and deaths — is being met.
“The only connection (between schools and bars) is that if bars continue to be a hot spot for COVID transmission and that has an impact on the capacity for hospital admissions and ICU beds then it could backfire on school reopening,” she said. “Though I don’t think that we’re at that level yet.”
Dr. David Buckeridge, an epidemiologist at Mcgill University, saw the issue of opening bars, generally, as distinct from the issue of opening schools. But if a connection was made showing that bars were jeopardizing the return to class, it would be easy for him to pick between the two.
“If (opening bars) means that we’re getting our community transmission up and maybe on the threshold at which it would seem wise to open schools, that does make you wonder where are our priorities?” he said.
“If I had to come down on one of those I would certainly come down more strongly on saying we should be thinking about getting schools open.”
Epidemiological trends suggest the virus will still be circulating in the community in the fall.
Public health measures, widespread testing and contact tracing should reduce some of the risk associated with sending children back to school. But many parents and school employees are worried because there are still things scientists do not know about how the virus spreads.
The WHO recently acknowledged that the coronavirus may spread as an aerosol, declaring that “short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons, cannot be ruled out.”
The prospect of coronavirus particles hovering suspended in poorly ventilated classrooms presents a new challenge, Buckeridge said. Public health officials will have to consider any way they can to reduce the spread of COVID-19 in the classroom “and some of that,” he said, “should be considering this risk that some of these virus particles might be suspended in the air.”
In Quebec, public health authorities gave the green light to reopening schools based on studies that suggest children do not get as sick as adults and do not spread the virus as easily.
Keeping schools closed comes with its own cost, said the experts contacted by the Montreal Gazette.
There is a real risk to children’s development, along with economic and other public health impacts that come with keeping schools closed.
“We can choose to open up the schools,” Oughton said, “but we do so knowing that there is a degree of risk to the children attending those schools as well as to the adults working in the schools . ... This is a really, really complicated decision and it’s not the kind of decision that we’ve been faced with very often in the past.”
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