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Krista McKeown stands at the school in northeastern Edmonton where her son Tristan, left, will return to class in September. She's worried about the rising COVID-19 cases in her area.

JASON FRANSON/The Globe and Mail

In four of Canada’s five largest cities, there is so little coronavirus circulating that most neighbourhoods meet the terms of a Harvard guide for safely reopening schools, as long as there are measures in place to control outbreaks, a Globe and Mail analysis has found.

The exception among big municipalities is Edmonton, where a recent spike in cases on the city’s north side could make it harder to keep COVID-19 out of the classroom. Higher-than-average case counts are also bedevilling a handful of other urban neighbourhoods, most of them home to poor and racialized residents whose essential work and high-density living conditions put them at greater risk of encountering the virus.

The Toronto District School Board, Canada’s largest, is directing extra money and capping class sizes at schools in high-risk areas, but boards in the other four cities aren’t – although they say they’re prepared to shift resources and tweak policies at high-risk schools as the academic year unfolds.

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As a September unlike any other draws closer, government officials, teachers’ unions and parents across the country have been fighting over how best to protect students and staff from the virus that causes COVID-19. While those in-class precautions, such as mandating masks and physical distancing, certainly matter, there is broad agreement among experts that what happens outside school walls is just as important – if not more so – as the safety measures implemented inside.

“Driving down transmission is the single biggest thing we can do,” says Ashish Jha, the director of Harvard University’s Global Health Institute.

A father comforts his four-year-old son at École élémentaire catholique Jonathan-Pitre in Manotick, Ont., on Aug. 19.

Dave Chan/The Globe and Mail

Given current levels of community transmission in Canada, is it safe to send the country’s students back to class? In a bid to answer that question, The Globe turned to a safe school reopening guide created by the Global Health Institute, Harvard’s Edmond J. Safra Center for Ethics and other groups at the university.

The Harvard document rates areas as green, or safest to reopen, if they are reporting one or fewer new daily infections per 100,000 people on a seven-day average. The guide designates areas as red, or unsafe to reopen, if new daily case counts top 25 per 100,000. In between are yellow (1-10 daily new cases per 100,000) and orange (10-25 new cases) levels that call for varying degrees of caution. The more community cases, the less safe schools will be.

At the provincial and territorial level, every Canadian jurisdiction except for British Columbia, Alberta and Manitoba is currently in the green zone of the Harvard scale. (By contrast, a map of the U.S. has very little green, a fair bit of red, and a lot of orange and yellow.)

The most recent data for B.C. has the province sitting at 1.36 new daily cases per 100,000, putting it at the lowest end of Harvard’s yellow zone. Alberta and Manitoba, meanwhile, are also at the low end of the yellow zone, with both logging an average of between two and three new infections a day per 100,000.

But provincewide case counts can obscure COVID-19 hotspots. Digging deeper, The Globe analyzed the most recent neighbourhood, area and borough-level data for Canada’s five largest cities: Toronto, Montreal, Calgary, Ottawa and Edmonton. (While Metro Vancouver has a population of nearly 2.5 million, the city itself has fewer than 700,000 residents.)

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Risk

level

Case

incidence*

Intensity of control

effort needed

Red

Over 25

Stay-at-home orders

necessary.

Orange

10 to 25

Interventions must be

used for control. Stay-at-

home orders are advised,

unless testing and contact

tracing capacity are at

levels meeting surge

indicator standards.

Yellow

1 to 10

Interventions must be

used for control.

Green

Fewer than 1

On track for containment.

Continued viral testing

and contact tracing are

advised.

*Daily new cases per 100,000 people

CALGARY

TORONTO

MONTREAL

Suppressed data

EDMONTON

OTTAWA

CHEN WANG AND MURAT YÜKSELIR / THE GLOBE

AND MAIL, SOURCES: TORONTO PUBLIC HEALTH;

CCSMTL; OTTAWA PUBLIC HEALTH; GOVERNMENT

OF ALBERTA

Risk

level

Case

incidence*

Intensity of control

effort needed

Red

Over 25

Stay-at-home orders

necessary.

Orange

10 to 25

Interventions must be

used for control. Stay-at-

home orders are advised,

unless testing and contact

tracing capacity are at

levels meeting surge

indicator standards.

Yellow

1 to 10

Interventions must be

used for control.

Green

Fewer than 1

On track for containment.

Continued viral testing

and contact tracing are

advised.

*Daily new cases per 100,000 people

CALGARY

TORONTO

MONTREAL

Suppressed data

EDMONTON

OTTAWA

CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL,

SOURCES: TORONTO PUBLIC HEALTH; CCSMTL; OTTAWA

PUBLIC HEALTH; GOVERNMENT OF ALBERTA

Risk

level

Case

incidence*

Intensity of control

effort needed

Red

Over 25

Stay-at-home orders necessary.

Orange

10 to 25

Interventions must be used for control. Stay-at-home

orders are advised, unless testing and contact tracing

capacity are at levels meeting surge indicator standards.

Yellow

1 to 10

Interventions must be used for control.

Green

Fewer than 1

On track for containment. Continued viral testing and

contact tracing are advised.

*Daily new cases per 100,000 people

EDMONTON

CALGARY

TORONTO

OTTAWA

MONTREAL

Suppressed data

CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCES: TORONTO PUBLIC

HEALTH; CCSMTL; OTTAWA PUBLIC HEALTH; GOVERNMENT OF ALBERTA

The analysis found that 52 per cent of residents in those five cities live in green zones, and 47 per cent live in yellow zones, where more caution may be warranted when the school year starts.

Only one part of the five cities – the Northgate area of Edmonton – is in the more dangerous orange zone, with a recent average of nearly 13 new daily COVID-19 infections per 100,000. In Toronto, 80 per cent of residents live in green zones, making it the safest large city in Canada in which to resume in-person learning.

“In most, if not all, places across Canada, you really should be able to open up school safely,” says Dr. Jha. “It’s not that there is zero risk. There’s never zero risk in the middle of a pandemic. But when I think about the level of disease in Canada, it’s like one-tenth that of California, and Canada and California are about the same size.”

The Globe’s analysis is a snapshot in time, based on August data. As COVID-19 cases rise and fall, the risk levels for neighbourhoods will change.

The Harvard guideline does not rely solely on daily new case counts. If testing is inadequate, such figures can underrepresent the true burden of COVID-19. Harvard also advises tracking virus-related deaths and hospital admissions – both of which are at near-record lows nationwide, despite minor increases in the West – and the percentage of tests that come back positive.

The World Health Organization advises that the positivity rate for comprehensive COVID-19 testing programs should be below 5 per cent. In Canada’s five largest cities, the positivity rates are as low as 0.3 per cent in Toronto and as high as 1.97 per cent in Edmonton, according to the most recent data. The positivity rate in Manitoba, currently the highest of any province, topped 3 per cent this week – something provincial officials attributed to targeted testing in clustered communities with known outbreaks.

At every colour-coded risk level, the Harvard guide recommends efforts be made to control the virus inside the classroom.

But in places with higher per-capita case counts, it urges more remote learning. For example, in the yellow zone, the guide says priority for in-class learning should be given first to children in preschool to Grade 5, then to those in Grades 6-8 and finally to high school students, who should be offered a blend of in-person and remote learning to allow for better physical distancing.

While the Public Health Agency of Canada (PHAC) has published general guidance for the reopening of elementary and high schools, it hasn’t released a tool like Harvard’s that assesses risk based on the level of community transmission. Eric Morrissette, a spokesman for PHAC, said by e-mail it would be up to local and provincial governments to produce their own tools, something that none have done specifically in the context of reopening schools.

Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, calls the Harvard guideline a useful start, but she said there is no “magic formula” that guarantees “everything is good to go” on the first day of school.

The local epidemiology and the quality of contact tracing matters, too, she says. If two cities with the same population report 10 new cases, but one of those cities can’t pinpoint where the new infections came from, “that’s more worrying,” says Dr. Tuite.

“The numbers alone are not necessarily going to tell you the complete story,” she adds.

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A student waits to enter Montreal's Philippe-Labarre Elementary School on Aug. 27, the first day classes resumed.

Paul Chiasson/The Canadian Press

Still, Andrew Morris, an infectious disease expert at Sinai Health System and the University Health Network in Toronto, says that as parents make their final decisions about whether to keep children home or send them back, it’s crucial they consider how much of the virus is circulating in their communities.

“If you’ve got one in five kids in the class who are infected, you can do as much as you want, but you are going to have transmission,” he says. “If you have almost no kids in your school with infection, or if you have zero kids in your school with infection, you’re not going to have disease transmission.”

That has mostly proved true in places that successfully undertook a partial reopening in the spring, including Denmark, Finland and Germany, where disease transmission was low when in-person learning resumed. The opposite has happened at some schools and colleges that have tried to reopen in parts of the United States, a country awash in what the Harvard guide calls high-transmission red zones.

In England, which welcomed some preschool and primary-school students back for a summer mini-term beginning June 1, COVID-19 infections and outbreaks were “uncommon across all educational settings.” There were a total of 30 outbreaks across the 23,400 schools, nurseries and other settings that were open by the end of the term, according to a Public Health England study.

As in most places that attempted a spring or summer reopening, England’s schools accommodated far fewer students than usual during the mini-term, with strict infection controls in place. Smaller classes and better hand hygiene undoubtedly helped, but the authors of the study, which has not yet been peer-reviewed, found a “strong correlation” between school outbreaks and regional incidence of COVID-19. In other words, the more transmission there was outside an English school, the likelier the virus was to find its way inside and spread.

In Canada, provincial governments, school boards and local public health officials should keep the level of community transmission in mind when setting school policies, Dr. Morris says. If a child turns up in class with achy muscles in North Bay – an Ontario city that currently has zero active cases of COVID-19 – her symptoms shouldn’t trigger the same level of alarm as they would in a coronavirus hot spot. “What we’ve allowed society to do is based on community rates of transmission,” says Dr. Morris. “We need a [similar] school response.”

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The Toronto District School Board (TDSB) took the levels of community transmission from the end of May until Aug. 16 into account when it decided to direct extra funding and create smaller classes at more than 75 schools considered to be at greater risk for COVID-19 outbreaks.

The schools are in pockets of Toronto with higher-than-average case tallies and higher proportions of residents who are racialized, have low incomes and live in multigenerational households, all factors that have been linked to more infections.

TORONTO

Humbermede: 6.43

Englemount-Lawrence: 5.75

TORONTO

Humbermede: 6.43

Englemount-Lawrence: 5.75

TORONTO

Humbermede: 6.43

Englemount-Lawrence: 5.75

Pelmo Park Public School, a kindergarten-to-Grade 5 school in northwest Toronto, is one of the schools on the high-risk list. The school itself is in a neighbourhood called Pelmo Park-Humberlea, which had an average of 1.33 new daily cases per 100,000 in the week leading up to Aug. 23 – putting it barely in the yellow category. But it borders on Humbermede, a neighbourhood with an average of 6.43 new daily cases in the same period, the highest in Toronto.

Mahaliah Thorpe, a mother of three sons, two of whom attend Pelmo Park, is planning to keep her children home for virtual learning at the family’s apartment, at least for the first part of the academic year. She is especially nervous at the thought of putting her boys on the school bus, where she suspects students will have a hard time staying apart. “I am very thankful that the TDSB is taking precautions, but my school is in a hot zone,” Ms. Thorpe says. “How are [students] going to use the bathroom? How are they going to use the water fountain? How are they really going to social distance? I think time will be the best measure of whether what TDSB has put in place really works.”

Mahaliah Thorpe of Toronto plans to keep her children home from Pelmo Park Public School, which is one of the institutions considered high-risk by the school board.

Jalani Morgan/The Globe and Mail

School boards in other major cities haven’t followed the TDSB’s lead in proactively identifying high-risk schools (with the help of Toronto Public Health) and sending extra resources their way to limit class sizes.

Quebec’s biggest schools service centre (the equivalent of a school board, after most of the province’s boards were abolished by a provincial law earlier this year) will not be providing additional funding to schools in hard-hit neighbourhoods this fall. Quebec students began returning to class on Thursday.

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“Funding is equal for all our schools,” says Alain Perron, spokesperson for the Centre des services scolaires de Montréal.

The province has moved instead to provide extra funding for students who have fallen behind academically because of the pandemic, with $20-million going toward hiring more than 300 professionals to help children catch up on schoolwork, especially those with learning disabilities.

MONTREAL

Suppressed data

Mont-Royal: 2.82

Kirkland: 7.09

MONTREAL

Suppressed data

Mont-Royal: 2.82

Kirkland: 7.09

MONTREAL

Suppressed data

Mont-Royal: 2.82

Kirkland: 7.09

Greater Montreal, once the epicentre of Canada’s COVID-19 epidemic, is now in dramatically better shape, with 47 per cent of residents living in green zones and most of the rest living at the low end of yellow. The outliers are the suburb of Kirkland and the Town of Mont-Royal, which reported averages of seven and nearly three new daily cases per 100,000, respectively, in the week leading up to Aug. 24.

The rest of Greater Montreal recorded fewer than two new cases a day per 100,000 in the same period.

The map looks similar in Ottawa and Calgary, where 44 per cent and 42 per cent, respectively, currently live in green areas, and the rest live in yellow zones, according to The Globe’s analysis.

OTTAWA

Beacon Hill-Cyrville: 5.30

Gloucester-Southgate: 3.04

OTTAWA

Beacon Hill-Cyrville: 5.30

Gloucester-Southgate: 3.04

OTTAWA

Beacon Hill-Cyrville: 5.30

Gloucester-Southgate: 3.04

CALGARY

Calgary-

Upper NE:

4.72

Calgary-

Lower NE:

4.01

CALGARY

Calgary-

Upper NE:

4.72

Calgary-

Lower NE:

4.01

CALGARY

Calgary-

Upper NE:

4.72

Calgary-

Lower NE:

4.01

The situation is more worrisome in Edmonton, where only 9 per cent of residents currently live in green zones, according to the most recent data. But it is also home to the only orange zone in the five cities The Globe studied. Along with Northgate, three other pockets of Edmonton – Northeast, Castle Downs and Abbottsfield – also have higher daily case counts per capita than any of the neighbourhoods in the other four cities.

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Edmonton-NE: 8.52

EDMONTON

Edmonton-

Northgate:

12.83

Edmonton-

Castle Downs:

8.51

Edmonton-

Abbottsfield:

7.86

Edmonton-NE: 8.52

EDMONTON

Edmonton-

Northgate:

12.83

Edmonton-

Castle Downs:

8.51

Edmonton-

Abbottsfield:

7.86

Edmonton-NE: 8.52

EDMONTON

Edmonton-Northgate:

12.83

Edmonton-Castle Downs:

8.51

Edmonton-

Abbottsfield:

7.86

Deena Hinshaw, Alberta’s Chief Medical Officer of Health, said this week that Edmonton’s surge in infections can be traced to indoor social gatherings, including weddings, funerals and family get-togethers. The city is also grappling with a major outbreak tied to the Bible Pentecostal Church in north Edmonton.

Krista McKeown’s 10-year-old son, Tristan, is preparing to start at St. Philip, a Catholic school in Edmonton Northgate. Ms. McKeown has decided to send him, despite her own immune system being compromised after years of battling anorexia. “Learning in front of his computer was not working,” she says. “It was a source of constant frustration.”

But as the case counts on the working-class north side of Edmonton have grown, so too has Ms. McKeown’s back-to-school anxiety. She would love to see the board reduce class sizes in schools more susceptible to coronavirus outbreaks. “That is one of my biggest concerns,” she says. “Our schools in the north part of Edmonton basically run at capacity.”

Spokespeople for Edmonton’s Catholic and public school boards both referred questions to the Ministry of Education. Colin Aitchison, press secretary to Alberta Education Minister Adriana LaGrange, replied by e-mail, saying: “If a board wishes to allocate more of their resources or set different policies at schools that are in higher-risk areas, they are allowed to do so.”

Ms. McKeown hopes Edmonton school officials will reduce class sizes in neighbourhoods more at risk of outbreaks.

JASON FRANSON/The Globe and Mail

In B.C., the smallest geographic areas for which up-to-date data is available are the province’s 16 local health service delivery areas. One of those areas covers the city of Vancouver, which reported an average of 2.95 cases per 100,000 in the 14 days leading up to Aug. 27, nearly double the 1.56 figure from the preceding reporting period.

Despite the increase, B.C. Provincial Health Officer Bonnie Henry stressed on Thursday that community transmission of COVID-19 remains well under control. “As we have seen around the world, what happens in schools reflects what is happening in the community,” she says. “We have very low levels of spread, or no spread, in most communities here in B.C.”

From Dr. Jha’s vantage point in the U.S., Canada’s back-to-school coronavirus transmission levels are to be envied.

”What I’m struggling with is your numbers are so great compared to almost every part of the United States. When you say you’re trying to drive down community transmission, my brain says you’ve already done it,” he says, laughing. “But you can probably do more. Everybody could do more.”

With a report from Eric Andrew-Gee


Photo illustration Marcelle Faucher/The Globe and Mail

About the data

Our analysis includes two main parts: the rate of new infections and the percentage of tests that come back positive. The Globe assembled province-level and municipality-level rates of new infections, along with neighbourhood, local health unit and borough-level data for Canada’s five largest cities: Toronto, Montreal, Calgary, Ottawa and Edmonton. Population sizes of the local areas vary across cities. For some small areas, one or two new cases can easily move them to a more dangerous risk level. Also, all the data reflects the home addresses of confirmed cases rather than where people caught the virus.

Not all cities report local-level data in the same format or at the same frequency. Where available, we used the most up-to-date seven-day average to calculate the rate of new infections. At the wards level, Ottawa Public Health only updates the cumulative number of cases every two weeks. The Globe collected copies of Aug. 3 and Aug. 17 data from OPH’s website and used the difference to get a 14-day average for our analysis. For Montreal, following the Montreal public health department’s disclosure terms, only the boroughs or linked cities with at least 100 cumulative cases are included in the analysis.


Your back-to-school questions answered

Watch Globe health columnist André Picard and senior editor Nicole MacIntyre discuss the many issues surrounding sending kids back to school. The Globe and Mail

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