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Kristy Denette, back left, untangles a headphone cord as her children Maverick, left, five, and Peyton, seven, do online schooling at the kitchen table in their home during the COVID-19 pandemic in Mississauga, Ont., on Jan. 5, 2021.Nathan Denette/The Canadian Press

Doctors are worried about the safety of in-class learning as schools prepare to reopen after the holidays.

Students in Alberta, Ontario and Quebec are learning remotely this week rather than returning to classrooms, a measure ministries of education introduced to help curb the spread of the coronavirus. In Manitoba, students in Grade 7 and up are taking online classes, and the government of Nova Scotia extended the holiday break. News reports said on Tuesday that Quebec is considering whether to delay the return to classrooms for another week.

Some provincial governments plan to bring children back to their physical classrooms within days, even as infections soar in many parts of the country and after the discovery of more-contagious variants of the virus.

Ronald Cohn, president of Toronto’s Hospital for Sick Children, said in an interview on Tuesday that if politicians reopen schools, given the high level of community transmission, safety measures, such as masks, physical distancing, cohorting and proper ventilation will have to be strictly followed. They would also need to institute a robust testing, tracing and isolation strategy for anyone who gets COVID-19, he said. Parents and educators have said crowded classrooms could be a problem, and many schools that lack ventilation systems have done little more than open windows.

“If we can’t guarantee that these things are in place, then I don’t feel comfortable that we’re opening schools given the current high and rising community level,” said Dr. Cohn, who is an expert in metabolic genetics and the hospital’s former pediatrician-in-chief.

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Governments and public health officials have said it is important to keep schools open, citing the mental and emotional toll on students of the abrupt closing in the spring. Having children in school also allows parents to work.

Ontario Education Minster Stephen Lecce wrote in a letter to parents on the weekend that elementary students would return next Monday. Some educators have called for more time away. High school students would resume in-class instruction in the following weeks, the government said.

“Medical leaders have been clear that schools are essential to the well-being, development and mental health of children,” Caitlin Clark, Mr. Lecce’s spokeswoman, said in an e-mail statement earlier this week.

Studies from some countries have shown closing schools has little effect on the spread of the virus, and the evidence favours more preventive measures, such as hand-washing and staying home when sick. However, a November article in the journal Nature said school closings in the U.S. reduced the spread of the virus and death rates.

The article, titled Ranking the effectiveness of worldwide COVID-19 government interventions, added a note of caution: Closing schools also has adverse consequences, including an interruption to learning, poor nutrition for some children, and social isolation.

The role of schools in transmission remains an evolving picture. Aside from testing in some regions of Ontario before the holidays, very little monitoring is done in schools.

“Has it been the apocalyptic nightmare that some predicted in the summer? No,” Dr. Cohn said. “But we don’t have the conclusive data right now to say how much potential transmission is happening in schools.”

It is clear that school-age children, as a group, tend to be less affected by COVID-19 than adults, although it can lead to serious illness or death in some.

It is far more difficult to determine whether children are less likely to transmit COVID-19. A report last month from the European Centre for Disease Control noted that while some evidence suggests children of preschool and primary school age are less likely than adolescents and adults to transmit the disease, those data may be skewed by the fact that children are also less likely to be tested.

What is known is that children can have asymptomatic cases of COVID-19 at least as often as adults, and can shed the virus in comparable quantities.

James Kellner, a pediatrician and professor at the University of Calgary, said that the more the disease is present in a community, the more schools are a factor as conduits of infection. He added that keeping schools open should remain a high priority, but that it is counterproductive to do so while the second wave of the pandemic appears to be growing.

“I think at the very least, [we need] a slightly longer pause now to see what the trends are in the disease,” Dr. Kellner said.

That judgement is echoed by Kim Lavoie, a clinical psychologist and Canada Research Chair in behavioural medicine at the University of Quebec at Montreal. Dr. Lavoie said statements from public officials about the impact of school closings on the mental health of children are not as well grounded in evidence as is sometimes implied, in part because other factors are in play, including economic stresses on families from the pandemic.

She added that governments need to be more transparent about why schools are closing or reopening, including linking actions to issues such as hospital capacity. Otherwise, reopening schools could imply the current situation is not serious.

“What we mandate sends a clear message about what is necessary,” said Dr. Lavoie, adding that keeping students home for four to six weeks would have a more meaningful impact on the spread of the virus than a week-to-week wait-and-see approach.

Ashleigh Tuite, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, said that in the fall, classes could be held outdoors, and windows could be opened wide for air circulation. In Ontario, Dr. Tuite said, the provincial government hasn’t made investments in proper ventilation or to reduce class sizes so students can physically distance in the colder weather.

“As long as cases are continuing to increase and as long as we’re not actually doing anything in the schools, it’s hard to see at what point that they are safe to open,” Dr. Tuite said.

Early evidence suggests new variants of the virus that originated in the U.K. and South Africa are more readily transmissible, and that the U.K. variant may also infect children more easily.

If that evidence is borne out and either variant becomes entrenched in Canada, “it would be a disaster for us, because we can only barely control the COVID we have now,” said Caroline Colijn, an epidemiologist at Simon Fraser University.

In a study last fall, Dr. Colijn and colleagues showed that outbreaks in schools are best contained when community infection rates are low, when classes are small, when ventilation and other environmental factors are optimized and when mass testing is used to catch asymptomatic cases – none of which is typical of how provinces are dealing with the pandemic in schools.

Heidi Yetman, head of the Quebec Provincial Association of Teachers, said her group asked the provincial government months ago for physical-distancing measures and ventilation. Those requests were not addressed.

“I really don’t think we can bring [the students] back,” she said. “Or we have to find a way to decrease class size and fix ventilation in schools. Why wasn’t this done before?”

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