As kids go back to school, some hope amid the fears

If you squint, or you live in hope, things might be getting better even as they get worse. The near-vertical Omicron wave has produced record COVID hospitalizations, rocketing ICU occupancy, more people on ventilators, and deaths that match the peak of the third, only partially vaccinated wave. Like every wave, this isn’t the flu.

But there are hopeful signs, maybe. Growth in daily hospitalizations is slowing — it was doubling every seven days in early January, and is only doubling every 12.6 days as of Thursday. Likewise, ICU is down to every 13.8 days, and ventilator use to every 11 days.

That those doubling times constitute an improvement tells you how steep the rise has been. Slowing growth is good, and at their current trajectory hospitalizations could peak by early next week. Test positivity is starting to drop; wastewater signals in Ottawa, Barrie, maybe even Windsor are showing declines, too. Ontario’s Omicron rise mirrored New York and London, and there are signs of improvement in those cities. None is identical to the others, but the broader picture might be.

It might, might, might be glints of good news. Infections in Ontario may well have hit an apex in cases already — Dr. Peter Juni, the scientific director of Ontario’s independent volunteer science table, estimates that between 10 and 15 per

cent of the province could be infectious at this moment, or one in nine or 10. That is a virus that is burning through your population fast. We haven’t been able to see cases for weeks now, so we have to guess.

If it is slowing it could be a combination of factors, as these things often are. The post-holiday is behind us. The latest restrictions were announced last week, and implemented over a week ago. Our booster coverage continues to increase, and now sits at 43.1 per cent of all adults in the province; infection confers some post-infection antibodies. Schools, which increase mobility in a number of ways, have been closed for almost a month. And the actual point of peak infections is a mystery. Hopefully, we keep slowing. It beats the alternative.

“Maybe, maybe, maybe,” said Dr. Isaac Bogoch, infectious diseases specialist at the University of Toronto and multiple Toronto hospitals. “The good signs are good. It can’t be bad.”

Even a slowing means ICUs lag hospitalizations by seven to 10 days, and deaths lag after that. In the best-case scenario we set more records for hospitalizations, push a battered ICU system very hard, and have to count a significant number of dead. Even a quick cases crash can leave a long tail. A province that can’t perform elective surgeries, has trouble finding beds in the hospitals, and is in constant danger of running out of staff is not in what you’d call great shape.

But it’s getting better, which brings us to schools. Ontario schools open Monday, and they are a thorny example of balancing harms. Kids should be in school; that should be, like hospitals, a societal priority. The data is not always clear-cut, but there are clearly harms that come from kids not being in school: virtual learning is an educational lottery, mental health and eating disorder data has been a concern during the pandemic, though the data is not unambiguous, or one-sided. Ideally, kids are in school.

But that also comes with challenges. Chief medical officer of health Dr. Kieran Moore insists schools only reflect community infection, but that’s a narrow view: schools greatly increase mobility, including allowing some parents to work in congregate situations.

“First of all we need to be aware that in the situation we’re in, the data previously collected and analyzed do not necessarily apply anymore: that’s the challenge now,” says Juni, who does advocate for a safe return to school. “So it’s clear that schools will reflect community transmission, but right now we’re not in the rain, we’re in the hurricane. And it’s very challenging to understand where this is going. And we need to be ready of course to adapt ourselves to disruption.”

Indeed, logistics may well be a nightmare. New York City mandates HEPA filters in classes and masking, reopened Jan. 3, and is now considering going virtual after Omicron roared through. No teachers, cohort collapsing, kids getting infected. Omicron is still everywhere.

Which is what made Ontario’s presentation on school reopening so frustrating Wednesday. Better masks for teachers, more HEPA filters, modified lunch situation, retired teachers for backfill, great. If that is what changed during the two-week delay — and we will find out — then that is at least improvement.

But given a month to come up with a plan, Ontario also decided that parents would not be alerted to an outbreak until a full 30 per cent of the school is not in attendance. This was kerosene. People can be absent from school for many reasons. But if 30 per cent of a class or school were home with COVID, which means symptomatic COVID because two rapid tests will last one sinus cold, then everybody in the place has been exposed. Recent New York state data showed hospitalizations by age group from Dec. 1 to Jan. 1 saw the greatest increases in 12-to-18-year-olds, then zero-tofour-year-olds, then five-to-11-yearolds. The increases ranged from 335 per cent to 1,047 per cent. That is not trivial.

“I do want to acknowledge though that the risk over the coming six to eight weeks will be higher, but we’ll get through it,” said Moore. “We’ll have a better February, and then a better March.”

We almost certainly will, and it will be a relief. We’ll know more by then whether schools can be run without significantly increasing spread, or whether they can be run at all. That Ontario’s government decided to increase the burn rate on the experiment, before clarifying that absence rates would be available on a website, was not encouraging for a lot of parents. It seems a recipe to let Omicron run.

Let’s hope that’s wrong. Either way, Omicron won’t run forever, and hopefully we can see the start of that. And that we don’t mess it up.

Given a month to come up with a plan, Ontario also decided that parents would not be alerted to an outbreak until a full 30 per cent of the school is not in attendance. This was kerosene