WILL MY KID BE SAFE?
In March, when world health officials declared a pandemic, the kids came home from school — and stayed home. Now, as schools across the GTA prepare to reopen, the Star asked a panel of experts what’s likely to go well and what could go wrong
It’s a question that has been on the minds of thousands of Ontario parents, students and teachers for some time now: just how safe is it to return to the classroom in the age of COVID-19?
School boards across the GTA have put forward plans with a variety of measures intended to keep students safe, such as asking students and staff to stay two metres apart, lowering class sizes, blocking off water fountains and requiring students in Grade 4 to 12 to wear masks.
But only once students and teachers are back in the classrooms will we truly know how effective these plans are.
Outbreaks will likely occur. Difficult decisions might have to be made. Premier Doug Ford has said there will likely be “bumps in the road” when school starts up again and that he will “not hesitate for a second” to close schools down if necessary.
The Star asked a number of experts — ranging from people who do pandemic modelling to doctors — for their sciencebased perspectives about measures school boards are taking to keep the spread of COVID-19 at bay.
Some common themes emerged. There was agreement that the smaller the class size, the better. Most agreed that running school buses at capacity was a bad idea. And while physical fitness is important, gym class should be held outside as much as possible.
There was some disagreement over whether it was realistic for parents to keep their kids home for two weeks at the slightest symptom of illness. And not all believe we will be able to make it through a full school year in classrooms.
Here then is our panel of experts with their thoughts to help guide us in the coming weeks. The comments have been edited for clarity and space.
Question: The GTA’s10 English public and Catholic boards are allowing elementary students in class as long as they’re socially distancing (in some boards desks are only one metre apart) and some are allowing students to work closely together as long as they’re wearing masks. Do you think that is safe or should elementary class size be reduced?
Answer: Dionne Aleman, industrial engineering professor and pandemic modeller:
There is evidence to suggest that one-metre distancing is almost as effective as two-metre. But, the one-metre and two-metre radii are derived from experiments with people talking at normal volumes and the distances that droplets from their noses and mouths spread. When kids are sitting at desks, are they talking in a normal conversational tone?
They are probably raising their hands to loudly ask questions to the teacher at the front of the room (or maybe yelling and horsing around with each other), which means that the one-metre or even two-metre distance may not be enough.
“The Ontario Public Health recommendation for other indoor settings has consistently been two metres for distancing. Schools should not be an exception.” Dr. Jennifer Kwan, family physician
Susan Bondy, epidemiologist: In public health there are really rarely going to be universally accepted thresholds for what is “safe” and “not safe.” Risks are always on a continuum and what is acceptable to one person, or family, is not acceptable to another ... also, even if we had well-researched and defensible risk numbers for a very specific context (e.g., differs by school, grade, and time), risk numbers are theoretical and abstract concepts. The fact is, some outbreaks are going to happen in some schools somewhere in Ontario. Raywat Deonandan, epidemiologist: Reducing class sizes should be the number one strategy and focus. Not only does it allow distancing but also limits the number of exposures experienced by any given person.
Jennifer Kwan, family physician: The Ontario Public Health recommendation for other indoor settings has consistently been two metres for distancing. Schools should not be an exception. Camille Lemieux, physician: The more measures a school can take the better. Redundancy that allows for increased safety should be what schools are aiming for, meaning it should not be either masking or distance but rather both.
Abdu Sharkawy, infectious diseases expert Every effort should be made to keep classes as small as possible. Masking will help reduce the risk of transmission but is not a substitute for distancing and this is very difficult to accomplish if class sizes are large. Working together less than two metres apart is inadvisable in my opinion, and creates unnecessary risk, especially if it is done for prolonged periods of time.
Question: Does arranging all the desks facing forward (as some boards are doing) really make a difference?
Dionne Aleman: It probably helps some, but probably not as much as wearing a mask during class. Students will still turn around in their desks to talk with their neighbours even if they are told not to.
Cynthia Carr. epidemiologist: We continue to learn about the role of the larger droplets (coughing, sneezing) vs. droplets from talking and singing vs. the possibility for infectivity by much smaller micronuclei that can stay airborne longer and float farther than then heavier cough or sneeze droplets (think spraying water from a Windex bottle vs. putting that water in a humidifier for example). However, this has not been defined as an airborne virus like the measles, so we are still learning and with that looking at harm reduction.
Camille Lemieux: I don’t believe there is any evidence that supports desk orientation having any impact.
Abdu Sharkawy: Not really. In reality, students are not facing forward 100 per cent of the time. They will be turning at all angles as a matter of habit and necessity.
At least one school board is allowing students to sing in class as long as they’re physically distancing. Do you think this is safe?
Dionne Aleman: Absolutely not. We have already seen at least two documented cases of COVID clusters arising from choir groups: one in Washington and one in Germany.When you sing, you are opening your mouth much wider — both inhaling and exhaling more air — and the evidence suggests that you are sending far more droplets at a longer distance. Susan Bondy: Any time one is speaking or exhaling forcefully there will be risk of spread — should the speaker be infected and in the infectious period. I doubt this has been studied so intensely as to separate the impact of those behaviours, but my expectation would be that banning singing completely, and only singing, isn’t going to make a clinically significant — or public health significant — difference in risk. Masks versus no-masks represents a far greater difference in risk than singing versus lecturing or laughing.
Cynthia Carr: I would not support singing right now even with a mask on. We know that the closer we are together, the more likelihood of spread. But there are cases of outbreaks in call centres where people were distanced. The more we talk or sing, the more likelihood for respiratory droplets. Raywat Deonandan: The evidence around singing is unclear. So far it seems that singing produces more aerosol transmission than simple talking. Given that, singing should be allowed only if, in addition to distancing, a good ventilation system reduces the chances of aerosol spread.
Jennifer Kwan: Singing is a high-risk activity due to the formation of aerosols and droplets distributed in the indoor space. It would only be considered safe if done outdoors, with masks and with two-metre distancing. Singing in an indoor classroom would be an unnecessary risk. Abdu Sharkawy: I don't think this is advisable. If the ventilation is not optimal, it is conceivable that some degree of aerosolized virus could travel from someone singing and be transmitted to someone more than two metres away.
The Toronto Catholic board is fixing windows so that in some schools they open 12 inches. Other schools have windows that only open a few inches. How important is good ventilation?
Dionne Aleman: Evidence suggests that good ventilation is important to prevent COVID spread, but it is not clear what makes ventilation good enough. I doubt that windows opening only a few inches makes much of a difference, but 12 inches might not be sufficient either.
Susan Bondy: There is some evidence, and a few outbreak studies, which suggest this virus can be moved by air in ventilation systems and so be transported to another person who becomes infected. It is a bit beyond being merely a theoretical possibility but still may be a rare occurrence. Good ventilation is an essential element of infection control where the risk is high and so the costs of a purpose-built ventilation system must be incurred.
Cynthia Carr: Recirculated air could be a possible factor in spreading the virus so ventilation is absolutely key. Even without ability to install an updated ventilation system, having doors and windows open will help bring in fresh air and potentially disburse the virus as opposed to a closed room with recirculated air. There should be no fans in the classroom recirculating air if windows are closed. Raywat Deonandan: Good ventilation is very important for mitigating that fraction of transmission that is caused by aerosols. I would say it's the fourth-most important strategy after lowering community incidence, making class sizes smaller and enforcing physical distancing.
Colin Furness, epidemiologist: Ventilation is key and fresh air is very safe – much better than recycled filtered air. You don’t want students sitting in a row such that air currents from the window will blow droplets from one person to the next. Some Plexiglas or other kind of diffuser in front of the window would help to dissipate air currents. Relying heavily on fresh air in the winter may make a classroom uncomfortably cold, however – and viruses thrive in cold dry air. I would not want to see cold dry air in classrooms for this reason, so I would recommend limiting open windows to a reasonable level in winter and using an air scrubber and a humidifier.
Dr. Camille Lemieux: Ventilation has been shown to have a positive impact with respect to other viral and bacterial infections. The number of times air is exchanged in an interior space can reduce transmission of droplet and airborne transmitted infections, a higher number of exchanges being better.
Abdu Sharkawy: Good ventilation is critical. And any ventilation is better than no ventilation.
Some school buses will be operating at capacity. What are your thoughts on the safety of this? How can parents keep their kids safe on buses?
Dionne Aleman: School buses at capacity is a terrible idea. You have kids from different grades and different classes in a tight, confined space, yelling across to each other. If anyone has COVID, it will spread, and it will spread to multiple classes and grades.
Sue Bondy: There have been some outbreaks in which travelling together in buses appears to have been an opportunity for transmission. The risk, though, is really driven by the rate of infection in the community and that is impossible for real people to know on a day-to-day basis beyond following general trends.
Cynthia Carr: Buses have risk factors: close proximity of sitting together, kids walking up and down the aisle getting on and off the bus and then the recirculation of air for both heating and cooling. I would want bus windows open and all kids wearing masks.
Raywat Deonandan: This is not an ideal scenario and I'd prefer if we'd invest in more buses and drivers to lower the density of people on each bus. However, in this circumstance we can lower risk by mandating both masks and face shields on the bus, having adult supervision on each bus to limit shenanigans and having reserved seating so that kids are always exposed to the same person, especially if that person is a classmate or sibling.
Colin Furness: That is very concerning because that is a lot of people in a small air space for a sustained period of time. Moreover, in my experience kids enjoy shrieking on buses, which increases droplet shedding. I would also worry about mask compliance on a bus given a propensity for boisterous behaviour. I’d like to see buses at about 25 per cent capacity.
Jennifer Kwan: School buses should require masks for all students (who can wear them), and also require two-metre distancing between students. Capacity may need to be reduced to allow for appropriate two metre distancing. Windows should be opened if possible, depending on the weather. A physical partition to protect bus drivers should be considered. Abdu Sharkawy: I have major concerns about school buses. Drivers are going to be at risk in particular and should be masked with a barrier in place and window open if possible. But kids will be hard-pressed to distance, especially if a bus is even half full in many cases. Even with masks, this worries me when we consider a ride could last an hour or longer in some cases.
Question: Is it realistic to ask parents to keep their kids home for two weeks at the slightest symptom of cold or illness, a requirement in some boards?
Dionne Aleman: I think some parents will flout this requirement, but it’s a reasonable request given that we are in the middle of a global pandemic emergency. Public health has to supersede individual convenience. Susan Bondy: In a pandemic? Yes, I think this is reasonable. The benefit to the public, in reducing actual risk and anxiety and the positive benefit of social modelling are considerable. We also know the requirement may have large impacts on some families.
Raywat Deonandan: It probably isn't realistic in the long run. But in the initial weeks it helps to assuage some concerns; and panic management is part of this endeavour. Ultimately a more comprehensive symptom-based diagnostic tool will have to be developed and shared with parents.
Colin Furness: That seems excessive.