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Should I keep my children home? Your back-to-school questions answered

TORONTO —
As Canada continues to battle the ongoing COVID-19 pandemic, parents and their children are preparing to face a very different school year with a return to classes weeks away.

While safety precautions in the classroom will vary depending on where you live, some parents still worry about the risk of sending their children back to the classroom with some choosing not to return to in-person classes at all.

From fears about taking the school bus to contracting COVID-19, CTVNews.ca asked viewers to submit their concerns about sending their children back to school. To help address some of their questions, CTVNews.ca spoke with infectious disease specialist Dr. Abdu Sharkawy.

Below is a transcript of the interview (edited for clarity and brevity):

1. Do you think it is safe for in-person classes to resume?

Dr. Abdu Sharkawy: Yes, but we have to talk about which classes and which schools. The problem with this situation is you’re dealing with a very wide spectrum of resources in terms of particular school boards, particular schools, the demographic within a certain community, and the constraints that they each face. Obviously, a rural school in Thunder Bay, Ont. has probably a lot less to worry about in terms of greater space, probably smaller class sizes, and a lower risk for community transmission compared to an inner city school in downtown Toronto.

We also have to be cognizant of the fact that if we do a really good job maintaining community transmission at a very low rate, there’s no reason to believe why we can’t have schools function and operate successfully. I’m not suggesting that outbreaks will not happen. I think I would be shocked if outbreaks didn’t happen and we should all expect that multiple outbreaks will happen. That doesn’t bring me any real sense of alarm or a sense of panic. The key is to make sure that our detection systems are operating very efficiently so that when we notice a cluster of cases occurring in a classroom or within a school that they are identified quickly and that contact tracing strategies are employed rapidly to ensure that the outbreak doesn’t spread and cause massive disruption within the school system.

We have to temper our fears here and recognize that the goal is not to prevent COVID-19 from getting into the school environment at all, because that’s simply not possible. The virus is still circulating within our community and even if it’s at a low level, it’s going to get into the school environment. The goal should be to minimize the spread and prevent a wide base of transmission as opposed to preventing it from getting into the school system altogether.

2. Some provinces where there have been lower COVID-19 numbers aren’t making any changes to their back to school plan. Is this the right line of thinking for these governments to take?

Dr. Sharkawy: No, I think that is a mistake. I think that there are various levels of risk and mitigation strategies that need to be employed, and that may include whether or not you want to use face masks throughout your entire student body, or whether you want to at least consider it for older children who we got fairly good epidemiologic data to suggest transmit the virus almost as rapidly as adults do. But to say that you’re going to go back ‘business as usual’ and expect that you’re not going to be falling prey to a virus that has not disappeared, I think is inadvisable. I think that’s foolhardy and governments who are going to employ this strategy will find themselves backtracking and having to change their policies as outbreaks emerge.

Until this virus disappears, it’s naive to suggest that it will not find its way into a congregate setting such as a school environment and it’s risky to be assuming that that doesn’t come with potential consequences for the entire community.

3. Some children who have underlying health problems like asthma may produce symptoms similar to COVID-19. Should parents simply keep their kids home if teachers can’t tell the difference?

Dr. Sharkawy: This is where we’re really going to need the co-ordination of really good testing protocols and public health guidance, and I think it speaks to the importance of more widely accessible rapid tests. There’s been a lot of attention given to the idea of saliva tests and other fairly user-friendly tests that can be performed outside of a medical environment — I think we need those. It is probably inevitable that in the first few weeks of going back to school parents will either opt to keep their kids at home if they’re symptomatic with something that is fairly nonspecific, or they will be sent home with a request to be tested and self-isolated until a test can be performed. That’s going to create some disruption, we should all be prepared for that and brace ourselves for but things will improve as we learn how to screen a little bit more judiciously to determine that something is probably much more likely to be in keeping with asthma or with allergies as opposed to COVID-19. This is going to be a work in progress, it’s going to take some practice before we find that comfort zone but there’s no simple solution for it. We’re going to have to go through a period of some inconvenience and some hassle because it just can’t be avoided.

4. Should masks be mandatory in all classes?

Dr. Sharkawy: It’s a consideration that should be strongly suggested, and I’m of the opinion that we probably have over thought the idea of the challenge that this will bring to kids, particularly younger ones. There’s all kinds of hand wringing and consternation expressed about the likelihood that the kids won’t tolerate masks, that they will be tugging at them and wearing them inappropriately, that they won’t know how to care for them properly and will be constantly contaminating them — I’m not sure where this comes out of other than sheer speculation and conjecture.

From my own personal experience with my own children wearing masks, they range in age from four to nine, and they don’t mind wearing their masks. They’ve gotten used to them, they enjoy wearing them because they’ve got colourful designs on them, and they think masks are cool. They have been taught how to take their mask off without making a mess on their face and contaminating them. They’ve been taught to put their masks away in a plastic bag that they can seal when they need to take it off for periods of time. To suggest that kids can’t be taught how to do this and they can’t be guided by school teachers and other staff within a school environment is a bit silly. It’s not going to be 100 per cent wrinkle free, but I think it’s more than possible.

5. Is there anything parents or teachers can do to ensure children wear masks properly?

Dr. Sharkawy: We need to make it something that is fun for kids, we need to make it something that is part of their personality. Whatever methods that teachers and resource staff can use to create a positive culture around mask wearing is really, really important. Unfortunately, masks have represented a lot of fear, a lot of suspicion, lack of trust, and infringement on personal freedoms in this pandemic and I don’t think we focused on the other narrative, which is that this is an expression of empowerment. Masks are an expression of safety, security, compassion, caring. You can even look at the aesthetic side of it where it’s an expression of our style, our personalities. Whatever we can do to create an environment for kids which allows them to recognize their masks as something that is fun, that is cool, that should be something they’re proud of, I think that would help.

Teachers are a lot more creative than I am when it comes to this in terms of whether they want to create incentives for kids somehow through wearing their masks properly to further the practice and to encourage them to do it. We can use all kinds of positive psychology to make this help rather than a hindrance.

6. Are class sizes of 20 or more too large to properly protect children?

Dr. Sharkawy: It comes back to the idea of what’s the given environment. If it’s a relatively newer school that was built in the past 20 years, you may have the resources and physical design of that given space to allow kids to distance safely. If you’re talking about an inner city school in downtown Toronto, then that may not be safe. [That school] is more likely to have difficulties with ventilation that is outdated, they may have just fewer resources in general to work with so that may be an unsafe situation. It’s important to employ as much creativity and try to think outside the box in terms of where you can move classes at least temporarily while weather permits into outdoor settings, and to utilize the funds that have been allocated by the provincial government in any given school board to try and use other facilities wherever possible.

7. Are school buses safe to use if they are full?

Dr. Sharkawy: I don’t think so. This is another logistical challenge that’s going to require some attention. Obviously, this is going to also come down to resource issues some boards may not have the freedom of running multiple school buses for the same class or the same school on a given day. School buses are not going to be designed to allow distancing within them by keeping seats empty so it would be my firm recommendation that everybody who’s on the school bus be wearing masks or some form of facial protection to minimize the risk.

8. How can parents and school boards protect children if they take a school bus?

Dr. Sharkawy: Masks are critical. A school bus is an indoor environment that is not terrifically well ventilated, and depending on the length of the ride to school — for some kids it can be upwards of 45 minutes or longer — that’s a significant exposure if someone is not properly protected. It’s important to make sure that hands are washed before getting on the bus, that hand sanitizer is provided on the bus at entry so that it just becomes a routine for disinfection to be maintained on your way in and out of the bus.

It’s especially critical for bus drivers to ensure that they are protected and perhaps that a Plexiglas or some other barrier be placed around them because they’re almost certainly going to be at a much greater risk of a problem if they’re infected with COVID-19 versus children on the bus itself.

9. Some parents are planning to keep their kids home for the first few weeks of classes. Is there any advantage to this?

Dr. Sharkawy: While it may be tempting to do that, the potential downside is that if enough people fall into that decision, you’re not really going to be testing the school environment to see if it’s up to snuff in terms of preventing the transmission of COVID-19. If it’s a select few parents that do that and if they have the flexibility that allows them to keep their kids at home, whether via distance learning or whether they’re going to be independently managing their children’s schooling, that may be to their advantage while they sort of see if the process is unfolding in a safe manner. But if enough people do that, you’re probably not allowing the ‘experiment’ to unfold as it should so you may be left with a misleading sense of security as to when you will send your kids back.

The other thing is that outbreaks may take a little longer to finally set in than people might think. It’s not a given that outbreaks are going to happen within the first week of getting our kids back to school. It may take a little while. I wouldn’t be completely surprised if we see outbreaks happening in early October than in the first few weeks of September. There’s no predictable calendar by which this is going to proceed positively or negatively.

10. If a child does get COVID, how should parents handle it?

Dr. Sharkawy: This is where it’s important to have very reliable and accessible public health guidance. If a child is symptomatic with COVID-19 and it’s confirmed that they have COVID-19, the rules won’t change. They’ll have to stay at home, they’ll have to self-isolate if they’re well enough to be at home and not to be admitted to hospital — which would be an unlikely scenario — and they will have to remain at home until they are symptom free or two weeks have passed, whichever of those is longer. Any member of that household will likely be advised to be tested for COVID-19 and will likely have to initiate self-isolation until they can be deemed negative to protect others in the community. It’s going to be a work in progress and a lot of it is going to depend on our testing resources and the ability of any given school environment to manage on a case by case basis.

11. Can bubbling a classroom really work if those children have siblings in other classes?

Dr. Sharkawy: Any degree of cohorting or bubbling to minimize the number of spheres of exposure between any one, particularly kids in a school environment, is desirable and certainly worth pursuing. Remember though, as soon as kids are really going back to schools, the concept of bubbles kind of disintegrates to a certain extent because everybody that they’re in contact with is bringing their own bubble into the experience. If you can minimize the number of those people with whom any particular child or student is interacting with, you minimize those fears of exposure further, and that is certainly a good thing. It shouldn’t really matter if there is a sibling in another class. That’s where it’s useful to do contact tracing and to be intelligent about our line of questioning when cases emerge in a given school environment so we can quickly screen through siblings and other members of the given household to determine if there’s a problem that needs to be identified there as the source.

12. Is there a way for children to safely take part in recess?

Dr. Sharkawy: Absolutely. Recess should be conducted outdoors. We have almost no evidence of outdoor transmission of COVID-19 in any age group. I think it’s healthy for children to be spending time outdoors physically and psychologically. It’s important for them to get fresh air and to get outside and that should be done pretty much year round unless weather conditions are obviously unsafe and entirely unsuitable. Luckily in Canada, we’re used to dealing with inclement weather and we can probably tolerate being outdoors more than a lot of other societies might be able to.

In the rare circumstance that recess needs to be held indoors, it should at least be in a gym space that is quite large if possible. You may even have to break recess up into potentially two different recesses where one group of kids goes at one time and another group of kids goes at another time to avoid unnecessary crowding.

13. Could sending kids back to school in waves be useful?

Dr. Sharkawy: It has a theoretical advantage of limiting the absolute number of children that are in an indoor environment at a given point in time. The disadvantage is that you then create a sort of flux between kids spending an inconsistent amount of time indoors and in the school environment versus in the community. Does it make more sense to do that at the expense of a lot of other issues that are going to have to adapt to that both in the home and work environment? Or does it make sense to try and actually make sure that the school environment is as safe as possible, and actually minimize the back and forth and feel as though the cohort within the school environment is safe and is free of COVID-19? Is it actually better to maximize the amount of time spent within that cohort as opposed to reducing that amount of time and including more time that is spent within the community? I don’t think we know the answer to that yet. This is something that is probably individually determined in terms of what makes the most sense for a given family or for a given school community and whether the resources are available to allow that to happen.

14. Could the return to school result in the start of a second wave?

Dr. Sharkawy: It’s possible. We’re dealing with a pretty big public institution that’s being opened up and we’re doing it across the country pretty much simultaneously so the risk is absolutely present. It’s undeniable, however I’m not pessimistic about our chances for being able to weather the storm and not to see a really calamitous situation unfold. We’ve done a great job over the course of the last two and a half months maintaining community transmission throughout almost every part of the country. We’ve done this while allowing the economy to reopen, we’ve done this while re-establishing social bonds and by in large, most people have been fairly adherent to distancing and masking and proper hand hygiene. There’s no reason to believe that if we don’t let our guard down with respect to all of those measures, we can minimize the amount of COVID-19 disruption and transmission that is going to happen through the reopening of schools. I’m trying to be optimistic about this and I’m hopeful that we’ll get through this relatively unscathed.

15. Is there an increased risk of transmission with air exchanges and vents?

Dr. Sharkawy: It depends on the status of those systems. Obviously, schools that were built 50, 60 years ago are unfortunately going to have outdated systems when it comes to ventilation. Many of them will definitely need retrofitting and that’s something that can’t be done very quickly. The number of are exchanges and the efficiency of any ventilation system is going to play a part in terms of increasing the risk of COVID-19.

If you’re talking about the possibility of aerosolization — the ventilation system itself being the reason why COVID might spread from one end of the school to another — that is a theoretical risk. We really don’t know how to quantify that risk but it is almost certainly present, and it speaks to the importance of trying to employ other strategies to prevent holding classes in indoor environments whenever possible or keeping windows open or updating older ventilation systems.

16. Should the sharing of tools be limited or prevented in classes like art and music?

Dr. Sharkawy: I don’t think that this is a major cause for concern. A sterile environment is no doubt critical to preventing the transmission of all kinds of diseases, not necessarily just COVID-19, but that being said, inanimate objects are not really believed to be a huge source of concern when it comes to the transmission of this virus. So if we’re going to invest our energies into preventing disease transmission, it should be on maintaining distance as much as possible and designing the school environment to allow that and facilitate that. It should be on improving ventilation in any particular learning environment and masking should be prioritized. Disinfection or the prevention tools being used between different kids is the lowest priority in terms of risk of transmission, so I don’t think that’s an issue that should be consuming much of our attention.

17. How frequently would custodians have to clean commons areas realistically to keep them safe for use?

Dr. Sharkawy: This should be done on a relatively routine basis but it will depend on the density of students within a given environment and the degree of use. I personally don’t feel that any more than once a day would be necessary. It comes back to this idea of where do we want to invest our resources in terms of risk mitigation. Desks, keyboards, light switches and tools that are used in arts and crafts, they’re not negligible in terms of their risk of COVID-19 transmission but they’re pretty darn close. This is very, very low on the worry scale.

18. Could holding classes outside help prevent potential spread?

Dr. Sharkawy: No question about it. We’ve got pretty good experience now from looking at Black Lives Matters protests and a whole host of other outdoor events where we might have expected to see COVID-19 transmission and outbreaks but the data just doesn’t bear that out. We should feel very confident that the outdoors is a safe environment to be in. Outside is the best place within which learning should happen and within which interaction with one another can happen. Every effort should be taken to try and pursue having the learning experience and the recreational experience in an outdoor setting if possible.

19. Crowded hallways have been seen in some schools in the U.S. What can be done to ensure this doesn’t happen here?

Dr. Sharkawy: This is where it’s important to ensure that the logistics and the design of timing of classes and entry and exits points are managed more appropriately. Each school is going to have to set up a timetable that determines when people can enter the school, through which entrances, the reverse for the end of day, and they are going to have to employ strategies like avoiding the use of lockers to prevent kids from being in close proximity to one another. I don’t think those are difficult strategies to try and put into place. They’re going to take a little bit of administrative work and it’s going to probably be a bit of a hassle to figure out what works most efficiently for any given school but I think it’s more than doable.

20. How far should desks be spaced to limit potential spread?

Dr. Sharkawy: We don’t want to adjust our concept of science to appease our appetites for convenience. Two metres, six feet was not a completely arbitrary recommendation in terms of distancing. I know that there has been a push to reduce this to one metre, I personally don’t feel very comfortable with that recommendation. I don’t think there’s enough evidence to suggest that that’s a safe recommendation. So I would say that desks be six feet apart whenever possible. If that’s not possible, that’s not possible, but every effort should be made to allow that to happen. That’s why it is so important to be wearing masks as well because if you can’t have six foot separation between students you got to have masks on at the same time especially if classes are going on for hours and hours a day.

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