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There are few more divisive issues in this pandemic than keeping schools open.

Ontario’s decision to keep many of its students at home and learning remotely – setting it apart from the rest of Canada – is under the microscope as the debate intensifies around transmission rates among children and the harmful social and academic effects of school closures.

The next few weeks will be critical as public-health officials examine what’s happening in provinces such as Quebec and Alberta, where almost all students have returned to in-class learning, and compare them with Ontario, which has once again extended closures in its hardest-hit regions.

“It’s clear that there’s huge grassroots pressure on the government to close schools … Some people want schools closed. What I’m saying is that there are harms there, and as soon as we can, we should get them open again,” said Chris Mackie, the Medical Officer of Health for the Middlesex-London Health Unit in Southwestern Ontario.

Almost a year into the pandemic, there is still no conclusive evidence regarding transmission in schools and to what extent children drive the spread of the virus. What is clear is that when kids contract COVID-19, they don’t tend to get seriously ill. But public-health officials worry that the new, more contagious variants of the virus will affect schools.

A report released last week by the U.S. Centers for Disease Control and Prevention suggests that outbreaks in schools have been “limited.” But the agency also highlighted the fact that, to have schools open, community transmission must be under control and mitigation strategies, including masks, must be implemented.

Janine McCready, an infectious-diseases physician at Toronto’s Michael Garron Hospital, said Ontario didn’t have much choice given the trajectory of infections. She acknowledged that having schools closed for extended periods could hurt children’s development, but with the province reporting more than 3,000 new cases daily, she said it is safer for children to be home.

Dr. McCready is part of a team that conducted an asymptomatic testing blitz at some Toronto schools before the December holiday break. The results are being analyzed to identify how transmission may have occurred.

“Even if you believe that schools don’t amplify spread very much, the whole act of having people leaving their homes, going to school, congregating in the playgrounds, picking up their kids … We’re in such a bad spot that everyone needs to get the message” to stay home, Dr. McCready said.

Quebec, which has a similar case trajectory, reopened schools to primary students last week with additional safety measures, such as masks in hallways for all students and in classrooms for Grades 5 and 6. It also imposed a curfew.

Meanwhile, the Ontario government has closed schools in Southern Ontario until Jan. 25 and has said that schools in Toronto, York Region, Peel Region, Windsor-Essex and Hamilton would remain closed until Feb. 10.

Karl Weiss, the chief of the infectious diseases division at Montreal’s Jewish General Hospital, said he believes schools have been a driver of the second wave of the pandemic in Quebec but closing them creates both learning and social issues. He said his government’s decision to mandate masks is a good step, but it also needs to closely monitor cases in schools.

“There is no good answer. There is a risk in opening schools, for sure, but it’s a calculated risk,” Dr. Weiss said.

That judgment is echoed by Dr. Mackie in London, who has come under fire for saying on social media that “schools being open is a public health measure that likely slows the spread of COVID.” Dr. Mackie explained in an interview last week that while schools are closed, many families are likely congregating because they need child care, especially parents who work outside the home.

He said the cases Ontario has seen in schools likely originated in the community, where transmission is high. In his area of the province, the public-health unit was able to trace at least 80 per cent of cases in schools back to the home. Furthermore, he said, his unit tested about 1,000 students in the fall who had come into contact with a case in their schools and about 1 per cent were positive.

“I think there are no easy choices right now. Every decision that we [make] to curb activities has negative consequences and potential benefits,” Dr. Mackie said.

Nisha Thampi, the medical director of infection prevention and control at the Children’s Hospital of Eastern Ontario, in Ottawa, said the data on the role schools play in transmission may not be conclusive, but in the meantime measures can be put in place to ensure students and staff are safe, including screening, testing and contact tracing.

“We know that the data are not perfect, but we also see schools as being an essential service for children and youth,” Dr. Thampi said.

“International evidence on school disruptions shows that “the impact of this is likely to be severe and it is likely to be more severe on children and communities that are already disadvantaged,” said Prachi Srivastava, an associate professor of education and global development at the University of Western Ontario.

She said early research from the Netherlands shows learning loss resulting from the spring lockdown. Ontario and other jurisdictions need to rethink how to deliver education, whether that means adjusting the school calendar or introducing remediation programs, to help students who have been in and out of school this year, she said.

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