Are we preparing for a safe school reopening? – RNAO asks once again

I am greatly concerned that once again the Ontario government is slow in acting to prepare schools for a safe and timely reopening in September.

The Ontario Science Table (ST) put out a report on July 19 with their advice on school reopening, which has raised controversy. The ST called for permanent measures that support the ongoing operation of schools, irrespective of the state of the COVID-19 pandemic, including vaccination of all eligible individuals, exclusion of sick students and staff, hand hygiene, adequate ventilation, and environmental cleaning. RNAO agrees with these measures, but we are gravely concerned about the lack of political transparency on the government’s plans to implement the ST recommendations. RNAO has raised many of these issues for over a year now (see here and here and here and here and here), and after a year and a half into the pandemic, and powerful vaccines on-hand, the path should be clear.   

One of the controversial recommendations issued by the ST – not supported by RNAO – is its position on masking, physical distancing and cohorting, which the ST refers to as “temporary measures” to be implemented at the health unit level according to the conditions present. The conditions present refer to the COVID-19 disease burden that in their view must be taken into consideration, such as student age, grade, and vaccination status. Social media posts suggested the ST report called for an end to masks and physical distancing at schools. When reading the report it becomes clear that is a misrepresentation, and the ST position is more nuanced than that. Nonetheless, RNAO strongly disagrees with any discussion of ditching the masks or any nuanced approach at this time. 

RNAO insists that masking should be seen as an essential and necessary component of the public health measures taken everywhere across the province in September. Dr. Kieran Moore, Ontario’s top doctor, has recognized that there may not be high enough levels of immunity across the province by September for kids to return to school unmasked. “It may be that we have a very cautious start in September and then monitor the situation because I don’t know that we’ll achieve that high community immunity that we need in September,” he said. Indeed, Dr. Nisha Thampi, one of the authors to the ST report, emphasized that the report does not recommend ditching masks in September – rather, the low-risk part of the framework is forward-looking to a time when rates and disease burden are very low and community immunity is very high.

RNAO says let’s not confuse parents, students, and teachers: Let’s be clear that masks and physical distancing are not in question for reopening of schools in September. We will have time to discuss relaxed conditions further in the future, likely next spring. Now is not the time to confuse the discussion and provide fodder for anti-maskers with a discussion of hypothetical conditions of very low risk for COVID. We will not be in such a situation in September. Masks for all children over 2 in kindergarten and schools this September!

A physician and mother, Dr. Jillian Horton calls in the Globe and Mail to continue with school mask mandates and physical distancing:

"A premature abandonment of these measures would also be an abandonment of every child with an underlying health issue, or whose siblings or parents have high-risk conditions. You want to cause a kid a lifetime of psychological harm? Set them up to be the vector for an infection that disables or kills their parent. After all, this isn’t only about whether COVID-19 can seriously sicken young kids – which it can. It’s about the ways in which kids exist in a vast, adult ecosystem. They are resilient, and they are also vulnerable. What valid reason could we have to abandon the simplest, evidence-based interventions that can help protect them from the Delta variant until they can be vaccinated, presumably by later this year?"

RNAO is gravely concerned also about another failing measure: ventilation. It has taken a long time to recognize that COVID-19 is transmitted primarily through aerosol – a point that Dr. David Fisman has systematically emphasized for a long time. The implications of COVID-19 being transmitted through aerosol are profound but slow in coming as they relate to public health measures and government policy. The ST informs that COVID-19 is primarily transmitted by aerosols and respiratory droplets during close unprotected contact, and it is recognized that aerosols play a role in longer range transmission, especially in poorly ventilated indoor areas. The ST report contains a detailed discussion on how to achieve and maintain adequate air quality through ventilation and filtration in schools.

As Dr. Horton says, “On the aerosol front, we aren’t listening closely enough to engineers, the experts who can help us understand the scope and nuance of the ventilation challenges in new and aging schools – a complex, heterogenous problem. What percentage of those schools have windows that are fused shut? What’s a realistic timeline for making even simple modifications? What about an adjunct CO2 monitoring strategy? Where is a commitment to put free-standing HEPA filters into every classroom?”

RNAO’s concern is not on identifying what should be done, which the experts in various fields have clearly delineated. Our concern is the lack of political will and sense of urgency to implement investments in school infrastructure that are necessary and costly, take time, and have traditionally not been seen as a priority. We are used to flashy buildings for financial institutions such as banks while schools remain in decrepit buildings. So many of our children study in physical environments that are crowded, poorly ventilated and not up to standards. Does it remind us of the state of long-term care homes, another RNAO issue of concern? Exactly, it does, in both cases – the poor status of long-term care homes and of schools – it reflects a shameful abdication of political and public policy responsibility.

Here is a reality check: Schools (in grades 7 and below) will house the largest population of unvaccinated people in congregate places starting in September. We should take the concerns expressed for over a year by RNAO, teachers, parents, and scientists seriously. Now epidemiologists warn of a fourth wave of COVID-19 driven by the dangerous Delta variant that will target the unvaccinated. Even if most children will have mild or no symptoms from COVID-19, they do and will transmit the illness to others who are more at risk. Unvaccinated school staff are particularly at risk, and thus the need for mandatory vaccination of school staff. This is similar to the call for mandatory vaccination of health care workers that RNAO has issued (with only medical exceptions).

How many unvaccinated people will be in schools in September is focal. ‘Time is of the essence now,’ Dr. Kieran Moore told reporters on Tuesday, July 20. Children younger than 12 cannot vaccinate, but children 12 and older, as well as school staff and parents, can do so. Unfortunately, time is running out. With 28 days between two doses of vaccines -- plus two weeks to build immunity following the second dose -- 6 weeks are minimally required from first dose to full vaccination. This week is the deadline for first dose for those who have not received any. And the need is great. Only about 35% of the 12–17-year-old cohort and about 46% of the 18-29 year-old cohort are fully vaccinated at this time. According to the Ontario government, widespread vaccination is a key aspect of Ontario’s plan to resume in-class learning in the fall but that plan has not yet been made public. To reiterate, RNAO is calling for mandatory vaccination of school staff. Let’s hope Premier Doug Ford and Minister of Education Stephen Lecce make an announcement this Monday. 

A year ago, on August 7, 2020, I wrote in this blog an article with the title “School reopening: Ontario government can still do the right thing on class sizes.” Today – 18 months into the pandemic and with clear science under our belt – we are still asking whether the government is doing the investments and providing policy directives to make our schools safe. Crucial investments are required in smaller class sizes, hiring teachers, improved ventilation and air quality, rapid testing and vaccination. Has the funding from the Federal government flowed from the province to the school boards and have the COVID-19 closures been utilized to do the building renovations and engineering work? Was this funding sufficient to meet the proper standards? We require full disclosure and full accountability from the government and school boards on these crucial matters. The government remains largely silent and provides few specifics. Parents, teachers and nurses should not be forced to keep asking. Governments exist to lead during good times and especially during difficult ones.   

That today is July 25 – less than 7 weeks from start of classes – and Minister Stephen Lecce has not yet made public his plan for reopening in September says it all. It appears we are continuing the approach of doing too little, too late that has been the trademark of the Ford government in addressing the pandemic. Let’s hope that tomorrow Monday, July 26, government officials – Premier Ford and Minister Lecce – will make their views and directives known. Doing otherwise will place at risk children, their families and teachers – and by extension, our communities. The fourth wave will be made worse than if we took seriously school preparation. 

Please see tweet and RT urgently.