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Grade 5 students attend class at Pacific Heights Elementary school, in Surrey, B.C., on June 12, 2020.DARRYL DYCK/The Globe and Mail

Ontario’s pediatric hospitals failed to reach a consensus on whether young children should wear masks when they return to school, leaving parents and school boards with lingering questions on how to safely reopen this fall.

The group of experts recommended the use of masks for high-school students, and perhaps even in middle school, when physical distancing can’t be maintained. However, the report said that 61 per cent of the experts agreed that elementary students should not be required to wear masks unless they choose to do so. A “significant minority” supported the use of masks for younger students when physical distancing is not possible.

The school guidance document, led by Toronto’s Hospital for Sick Children and released on Wednesday, made recommendations on physical distancing in classrooms and other health and safety measures, while noting that the use of masks in schools is a “complex and nuanced issue.”

“Given that there has been considerable disagreement among the authors around this issue, it will be critical to assess the use of masks on an ongoing basis throughout the school year and adjust accordingly based on the development of further evidence, changes and epidemiology,” the report says.

Ontario will announce its school-reopening decision on Thursday and the pediatric hospital document will inform the government’s back-to-school plan. Other provinces, including British Columbia, Alberta, Saskatchewan and Nova Scotia, have said their students will return full-time, with health and safety measures.

The B.C. government said Wednesday it would not mandate the use of masks in schools, but would put $45.6-million toward safety measures including cleaning high-contact surfaces and more hand-washing stations.

In its plan, the Nova Scotia government said high school students and teachers will be required to wear masks in hallways and common areas, and all students would also wear masks on buses.

Non-medical masks have become commonplace in grocery stores, movie theatres and churches. Yet educators, medial experts and families are divided on their use and effectiveness in schools, particularly among young children. There is a lack of evidence on the use of masks among children and youth. In Asian countries, children have worn masks to school, but that’s not the case in several European countries.

Jeffrey Pernica, medical director of pediatric infectious disease service at McMaster Children’s Hospital, which collaborated on the report, said children touch their face more when wearing masks, leading to more infections, and youngsters need to see facial expressions for language and social development. Further, masks need to be worn correctly to be effective, which could be difficult for healthy children to do for an entire school day. Those with underlying medical, developmental and mental health conditions find it more difficult.

Young children less likely to spread coronavirus, McMaster review shows

“The lower the level of COVID in the community, in the school, the less benefit there is with masking, but the harms remain the same,” Dr. Pernica said. “This is why our recommendations are what they are right now. And should the epidemiology of COVID-19 change dramatically, our recommendations will also probably change.”

The Alberta Teachers’ Association said it doesn’t have a formal position on the universal use of masks because the evidence is not conclusive. But Sam Hammond, president of the Elementary Teachers’ Federation of Ontario, said masks can be important especially when physical distancing will be challenging among young children. The report from the pediatric hospitals recommends one-metre distancing in elementary classrooms in Ontario, and two metres for high schools.

“If a region has declared masks mandatory for indoor spaces, then we expect masks to be mandatory in schools in that region, regardless of age,” Mr. Hammond said.

Susy Hota, medical director of infection prevention and control at Toronto’s University Health Network, said education officials should at least be open to a mask requirement for children when they return to the classroom. She acknowledged that children – especially younger children – could struggle to keep their masks on properly.

“I think when it comes to opening schools, we’re going to have to all be willing to accept that it’s going to change over time, potentially,” she said. “We may have to layer some of the interventions that we put in. So masking might be one of those things that we introduce if [infection control] is not working otherwise.”

Evidence suggests that young children, particularly those under the age of 10, are less likely than teenagers and adults to spread the coronavirus. Still, some experts have warned that transmission could be underestimated because many children with COVID-19 have no symptoms and are less likely to be tested.

William Carruthers, a Grade 11 student at Citadel High School in Halifax, has teamed up with friends to prepare for a safe return to school and focused on persuading younger children to mask up. The group is hoping to speak in elementary schools to make sure students are comfortable wearing masks and understand how it protects them and others.

“We realize that mask wearing in school is new to us, and even we had some apprehension with wearing the mask, because of how new it was and we didn’t fully understand it,” Mr. Carruthers said. “By making sure that kids feel comfortable wearing the masks ... it will help ensure that there aren’t any major outbreaks in schools and keep schools open for longer if a second wave occurs.”

Renee Gillette, a parent to a seven-year-old and a high-school teacher in Abbotsford, B.C., said that while she understands that some families may be reluctant to put their children in masks all day, “I also don’t think we give kids enough credit.”

Ms. Gillette said she’s nervous to enter her classroom, and she would like her students wearing masks, for her safety and theirs.

“I asked my daughter, ‘Would you wear a mask if your teacher asked you to?’ And she said, ‘Well, I wouldn’t like it, but I would do it and I would understand,’ " Ms. Gillette said. “If you have honest conversations with kids and you’re open and you explain why you’re doing something, there’s a huge buy-in.”

With a report from Kelly Grant

Canada's chief medical officer Dr. Theresa Tam says active discussions are taking place to potentially pre-order COVID-19 vaccine doses for Canadians.

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