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School outbreaks of COVID-19 will happen. Doctors offer tips to keep them in check

As schools across Canada finalize their back-to-class plans, doctors say there are a few things educators and parents should keep in mind during COVID-19.

People will form new routines that build on the advice provincial medical officers of health regularly share about hand washing, avoiding touching your face and trying to keep two metres away from others. Schools will now put students into smaller groups, check ventilation and consider use of masks.

Cases of COVID-19 haven't overwhelmed health systems in Canada thanks to collective sacrifices, but cases continue to occur. 

CBC News is breaking down need-to-know information on the pandemic based on questions sent via email to COVID@cbc.ca. Here, physicians offer advice and answer questions on back-to-school topics like distancing, health checks, safe nap times and when to stay home.

Dr. Lisa Barrett, an infectious diseases physician at Dalhousie University in Halifax, said keeping school as safe as possible for kids to learn and socialize doesn't follow a set timetable.

Evidence suggests toddlers actually have less chance of transmitting COVID-19 than a 20-year-old who is napping, said Dr. Laura Sauvé, a pediatric infectious disease specialist at the University of British Columbia. (Fiona-Lee Quimby/Fairfax Media/Getty)

By necessity, she said, school plans can't be perfect and people won't follow all of the basics to the letter at all times.

"If we don't do a better job of tracking and tracing, then some of these school plans … are going to fail, and we're going to see outbreaks and clusters we can't control," she said.

Layering public health measures for all Canadians on top of testing and contact tracing aims to keep outbreaks manageable. 

Priority 1: Keep COVID-19 out

Many school boards have not yet offered details on what they'll be implementing to keep children safe and how. Until then, infectious disease and public health experts say some precautions will be the most effective.

Infectious disease physicians stress prevention before control — meaning they'd like to keep the novel coronavirus out of schools altogether.

That's why they, along with pediatricians and epidemiologists, repeat that people need to stay home when sick. Doing so prevents an individual's illness from sparking more.

Dr. Laura Sauvé, a pediatric infectious disease specialist at the University of British Columbia, said public health, school authorities and infectious disease specialists are collaborating closely across the country.

"Public health authorities are trying their best to balance multiple competing priorities keeping in mind the whole child," Sauvé said.

WATCH l Physical distancing in schools:

Dr. Christopher Labos says there is little value in testing every child for the coronavirus before school starts and he speaks to concerns about keeping kids apart in the classroom. 5:43

Priority 2: Check frequently for symptoms

Recognizing a sickness and acting on it is a major layer of defence to keep COVID-19 out of schools.

Sauvé's son is heading into Grade 4. When he attended day camp in B.C. this summer, she said there were either sign-in sheets or a daily email requiring parents to declare the child is not sick.

"It's not so much the signing. It's the fact that every day we're checking in with ourselves and saying, 'Am I sick today? Do I have any symptoms?'" she said. "And if there's any way I could have symptoms, I need to stay away and reassess. If I get worse, get a test."

Distancing students inside is the most important consideration in reopening schools, according to Dr. Lisa Barrett, an infectious diseases physician at Dalhousie University in Halifax. (Sean Young/CBC)

To emphasize the stay-home message, schools and workplaces plan to send notices home, and provincial health officers will give regular reminders, she said.

Priority 3: Stay apart

Public health experts have repeatedly stressed that physical distancing is key to preventing the spread of COVID-19, but how that will play out in schools with small classrooms and large numbers remains to be seen.

Andisha A., a Grade 11 student in Calgary, sent the this question to Ask CBC: "How can I be safe when my classroom is full, with not a lot of social distancing going around? The school board is also not forcing students to wear a mask?"

The federal government's COVID-19 guidance for schools resource emphasizes separating people from each other through physical distancing and barriers as more protective than what individuals can do, such as covering coughs, hand washing or wearing non-medical masks.

To that end, local medical officers of health in Toronto, Hamilton and Ottawa have called for smaller class sizes.

"Ottawa Public Health supports having the number of students within a classroom to be as small as possible, in order to facilitate appropriate physical distancing, and to maintain distancing and limit the mixing of cohorts in common areas such as hallways and washrooms," Dr. Brent Moloughney, the city's associate medical officer of health said in a statement on Tuesday.  

Fen Bohen, 9, of Gibsonia, Pa., participates in an obstacle course with fellow campers on June 11 at Camp Guyasuta in Sharpsburg. Schools across Canad are rolling out protocols to keep children safe during the COVID-19 pandemic. (Michael M. Santiago/Pittsburgh Post-Gazette/The Associated Press)

Provincial recommendations to school boards are also subject to change.

Masks are another issue school boards are tackling differently. In Alberta, students from Grades 4 through 12 will be required to wear masks in all public spaces like hallways and can choose to wear them while seated in the class. Masks will be optional for younger students. Quebec's plans are similar. Ontario requires masks in Grades 4 to 12.

Priority 4: Ventilation  

Lorna C. asked, "What is the plan to ensure safe air flow and humane working temperatures in elementary schools without air conditioning?"

At her clinic, Sauvé said fans are generally avoided to prevent the spread of fungal spores but they are turned on since it can get as hot as 35 C inside.

For schools, Sauvé said opening windows is encouraged.

Provincial occupational health and safety committees have more specific recommendations on ventilation in school. 

Priority 5: Personal protective equipment

Dr. Catherine Clase, a nephrologist at St. Joseph's Healthcare in Hamilton, Ont., applauds Andisha for being proactive about staying safe at school 

Clase suggests fabric masks for students, which she first proposed for her kidney patients. Some school boards across Canada are making masks mandatory for secondary school students. 

"If [masks] are normalized in school and we have conversations and kids are not shamed for doing it wrong I think that's going to be really important," Sauvé said. "Everything we do has to be done with the thought of kindness and support." 

Clase hopes people will create shareable videos to encourage proper use.

Making masks attractive to children would help and some trial and error could be in order, she said.

Sauvé suspects that with encouragement and redirection, most children will be able to get used to wearing masks, which are not the "be all and end all" of protection.

Monica N. asked about how often to change a mask during a six-hour day with Grade 3 students. 

If families have the resources, then both Clase and Sauvé suggest providing two facial coverings each day to change at lunch or if one becomes soiled.

"We need to be planning for at least one clean mask for every person going outside the house every morning," Clase said.

Hand sanitizer and spaced-out desks, labelled for a specific cohort of student, are some of the changes being made in secondary schools. (Stacey Janzer/CBC)

Sophie D. said "physical distancing is not possible with infants, toddlers, or preschoolers, especially during nap time when up to 24 children sleep on cots close together. Will masks really protect educators in this environment?"

Likely, yes. "You will get protection from wearing a mask," Clase said.

Sauvé said sleeping children are also not coughing and running around.

"Evidence suggests that toddlers would transmit less than a 20-year-old having a nap."

Schools aren't the most dangerous place

Doctors and scientists also know more about the virus than when schools abruptly closed back in March, when the pandemic was taking hold in Canada.

The bulk of evidence globally shows some kids will get very sick with COVID-19, but overall they get much milder disease symptoms than adults, Sauvé said.

"Of kids who get it, about 80 per cent get it from somebody in their household … even in settings where kids are getting back to school and back to daycare," she said.

It also appears that young children transmit the virus less than older kids. There's no clear age cutoff, according to Sauvé.


Keep your questions coming by emailing us at COVID@cbc.ca.

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source https://www.cbc.ca/news/health/covid-19-school-infection-prevention-1.5681326?cmp=rss

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