Plan to reopen schools based on flawed data
Available anecdotal and scientific evidence supports the need to open schools safely. Ontario’s school reopening plan relies on a document produced by Sick Kids, one part of which reviewed the evidence that children may not transmit the COVID-19 virus as readily as adults. Therefore, Ontario felt it was safe to open middle and elementary grades without cutting class sizes to improve physical separation.
I have reviewed the same evidence as the Sick Kids document and have come to different conclusions. Reading the source references suggests most of the evidence about transmission in children is anecdotal or based on modelling. Aggregation of poor evidence into a metaanalysis does not improve the quality of the evidence. The plural of “anecdote” is not “data.”
Subsequent to the Sick Kids report, new evidence has been published that suggests children may have more viral load, and may transmit the virus as much or more than adults. Whatever the actual transmission rate, however, there is no doubt children do transmit the virus to others, with children over 10 as frequently as adults do. Because children are less symptomatic, it is by stealth — no one knows they are sick, but they are contagious anyway.
We also know that many jurisdictions that reopened schools have had to close them again (e.g. Israel, originally cited in the Sick Kids report as a success.)
Children generally do not suffer severe illness from COVID. Their risk is of the same magnitude as other things we do every day, like driving on a highway. Some children are exceptions and need more protection, but the main issue is the safety of those with whom they are in contact.
When faced with uncertainty in medicine, we act by looking not only at the risk, but also at the consequences of being wrong. With schools, the consequence is spread of the virus to the children’s contacts — (teachers, support staff, parents, grandparents and others in their homes) leading to a second wave and a second lockdown.
All risk mitigation strategies work together to reduce risk; there is no single magic bullet. But we do know that the top two are physical distancing all the time and mask-wearing indoors.
Middle schools with children ages 10 and older are no different in risk profile than high schools, and having children 10 and up in schools full time with class sizes of 30 is an unforced error that needs to be corrected as quickly as possible. Given how this virus exploits any weakness, it is prudent to include physical distancing measures in younger children as well.
AHarvard School of Public Health document states: “… there are unique behavioural factors in this age group that can facilitate the spread of infectious disease … it is reasonable and prudent to assume that COVID-19 transmission may occur between children and from children to adults in reopened U.S. schools.”
Teachers should be considered no differently than pediatricians or family doctors. Whatever protective measures are being used for these nonhospital health-care workers should be in place for teachers as well. This includes effective PPE and physical distancing, as well as all of the 16 riskmitigation strategies on page 7 of the Sick Kids report.
Proper physical distancing necessitates more teachers and more space. Since all strategies work in concert to reduce transmission, ignoring physical distancing completely while at the same time knowing that not all the other strategies can be followed all the time creates a weak link and is likely to lead to failure of the whole system.
No teachers should have to do in-person education if they put themselves or others at significant risk. A healthy teacher with a spouse undergoing chemotherapy should not be in front of a classroom. A young teacher with an important pre-existing condition should not be in front of a classroom.
Spending money now to implement all the known risk-mitigation tactics is far less costly than a second lockdown. School opening should use every possible preventive measure. We’ll look like fools if a second wave occurs and we didn’t.