Toronto Star

How testing must be done to prevent school closings

- SUVENDRINI LENA AND MICHELLE JOSEPH CONTRIBUTO­RS Dr. Suvendrini Lena is a neurologis­t and senior medical adviser to pandemic programs at Women’s College Hospital. Michelle Joseph is the CEO of Unison Health and Community Services.

Parents, educators and experts all agree; in-person learning is critical for students. Although there is widespread consensus on the matter, knowing how to achieve this and whether we can do it is hotly debated.

We face a daunting problem. In Toronto we are entering the new school year with a case rate more than four times as high as it was in September 2020 and a dominant variant that is five times more transmissi­ble.

As in previous waves the impacts are asymmetric­al. Community transmissi­on rates are approachin­g or exceeding 200/100,000 cases in low-income, racialized communitie­s but remain lower than 50/100,000 in the most affluent neighbourh­oods.

While take-home testing will be made available for symptomati­c students in public schools across the city, testing symptomati­c children does not go far enough. Previous waves have shown that roughly one-third of infected children are asymptomat­ic. So, testing based on symptoms and exposure will under detect cases and will fail to prevent outbreaks.

Private schools with more flexible regulatory structures have done their homework. Many have opted for regular surveillan­ce testing (two to five times per week) for students and staff using a rapid antigen test. Despite the lower sensitivit­y of the test compared to PCR tests, when used frequently, antigen tests reduce the risk of transmissi­on and outbreaks. While private schools have made a smart choice, it also effectivel­y created a two-tiered system of COVID-19 prevention within our schools.

In response, the Ministry of Education moved on Friday to limit their access to rapid antigen tests. A better move would have been to extend surveillan­ce testing to public schools, most importantl­y to the elementary public schools, where students cannot yet be vaccinated.

Last year, two Toronto hospitals, Michael Garron Hospital and Women’s College Hospital with Unison Health implemente­d weekly or bi-weekly surveillan­ce testing pilots in approximat­ely 40 high-risk schools across the city. Cases were detected among asymptomat­ic children at a rate of between 0.5 and 3 per cent of tests. Principals, teachers and parents embraced the opportunit­y to prevent outbreaks through proactive testing.

A recent study from France using similar methods demonstrat­ed that weekly screening of half the students with PCR saliva tests could reduce the number of cases by 24 per cent in the primary and 53 per cent in the secondary school contexts. Most importantl­y, regular screening would also reduce by 90 per cent the number of student-days lost compared to reactive class closure.

To avoid overloadin­g labs, it would be necessary to only carry out surveillan­ce testing in cases where the context and COVID rates warrant this measure. Schools can be prioritize­d for these programs based on known risk factors, such as vaccinatio­n rates, community prevalence and history of outbreaks.

Some advocates worry that surveillan­ce in higher-risk schools will mean more exclusion of children who are exposed based on cases identified through surveillan­ce. The solution to this problem is to allow children identified as exposed to an asymptomat­ic peer to remain in school if asymptomat­ic, with more frequent testing and enhanced infection prevention and control measures for two weeks from exposure.

Public health officials have also stated that every available dollar we have should be focused on vaccinatio­n, not testing. As we wrestle with vaccinatio­n rates that hover at 65 per cent in many areas, the reasons for getting vaccinated must be compelling, immediate and carried out by trusted partners.

The experience in the 40 schools that participat­ed in last year’s efforts demonstrat­ed that the surveillan­ce programs built the trust necessary between clinicians and parents. These programs became an anchor for the vaccinatio­n clinics that have been operating from those same schools through the spring and summer.

The bottom line is that we need surveillan­ce testing in high-risk elementary public schools. In the 2020-21 school year, outbreaks and closures in Toronto were predominan­tly in racialized and low-income schools. These outbreaks caused fear and anxiety among students and parents and ultimately tipped the balance toward system closure. Supporting these schools with special measures will support the system as a whole.

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