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In early November, Aimee Quesnele, a mother of three, was told her daughter had been exposed to COVID-19 at school, which was followed a couple of weeks later with news that her son had been exposed in hockey, and then later in his own classroom.

The overlapping exposure notices meant all three of her children – in kindergarten, Grade 2 and Grade 4 – were either home or took turns learning remotely for the better part of a month.

They returned to their classrooms last week.

Her city of Sudbury, like many other parts of Northern Ontario, is facing a major surge in COVID-19 cases, with spikes in school-aged children leading the way. The 14-day rate of COVID-19 cases in children aged 5 to 11 in Sudbury was 977 per 100,000 on Tuesday, compared with a provincial average of 197 per 100,000.

“We’re feeling exhausted and stress levels are higher than they were,” Ms. Quesnele said of the situation in her city.

It’s unclear why smaller, more remote cities are facing such a surge in cases right now. About 84 per cent of people 12 and older in the Sudbury region, for example, have received two doses of a COVID-19 vaccine, compared with a provincial average of 87 per cent.

Some experts say it’s possible that pockets of unvaccinated individuals in smaller cities may be more likely to know each other and interact, whereas in larger cities, unvaccinated individuals are more spread out.

“When you have a lot of unvaccinated individuals that are linked together … it can spread pretty quickly,” said Zain Chagla, an infectious-disease physician in Hamilton. “[COVID-19] is going to find people in those networks.”

In Sudbury, the public-health unit has encouraged virtual-only assemblies in elementary and secondary schools, recommended a pause on field trips that require group transportation or are not outdoors, and urged schools to mandate masks for students while outdoors and if physical distancing cannot be maintained. The Rainbow District School Board said it has HEPA filters in kindergarten rooms and classrooms with no mechanical ventilation.

Public Health Sudbury & Districts has also recommended that local schools require a negative rapid antigen test for students aged five and older to participate in indoor, high-contact extracurricular sports in cases where students aren’t vaccinated.

Further, the health unit recently distributed five rapid antigen tests to all students in the region as a way to control case spread in schools. Students are being instructed to take a test every three days, which should allow the tests to last until the holidays, when the province has pledged to provide five more for students to take home.

Ms. Quesnele was pleased to see the rapid tests sent home in backpacks last week. Her children, she said, “treat it like a little science experiment.”

“If there’s a chance that it can find positive cases before going into school, then that’s great. We’re happy to do it if they think it will help,” she said.

Joëlle Martel, a health promoter with Public Health Sudbury & Districts, said cases are being detected in various settings throughout the region, including workplaces and different types of social gatherings.

There were 241 active COVID-19 cases in Sudbury as of Monday evening, with the highest case rates being among those 19 and under, particularly among those 5 to 11. Nationally, case rates among children and teenagers have been increasing since last August. In Ontario, specifically, 15 per cent of all cases are related to schools, compared with 7 per cent at this time last year. Primary schools are the top outbreak setting in both Ontario and Quebec, and it continues to be on the rise.

In Sudbury, Ms. Martel said many parents rushed to get their five- to 11-year-olds vaccinated once the COVID-19 vaccine for kids in that age group was approved last month. “We keep getting more bookings coming in every day,” she said.

The vaccination rate in kids 5 to 11 in the Sudbury region was 18.8 per cent as of Monday evening, slightly lower than the provincial average of 20 per cent.

Public-health officials are taking steps to reduce the spread of cases in the region, with a particular focus on kids. Last month, Public Health Sudbury & Districts reinstated some restrictions, including capping capacity at arenas, pools and gyms to 50 per cent.

As more people gather indoors, especially over the holidays, there are fears that the spike of cases among children could spill over to more vulnerable adults.

Medical experts are also concerned that hospitals in smaller cities could be overwhelmed in the coming weeks. Dominic Giroux, the CEO of Health Sciences North, a large regional hospital serving northeastern Ontario, said a record number of COVID-19 patients have been admitted in the past month. There are currently 20 COVID-19 patients admitted at Health Sciences North, including seven in the ICU. That represents nearly 30 per cent of the hospital’s ICU capacity. The hospital has been forced to reduce the number of surgeries.

“There’s no doubt that it’s a challenge,” Mr. Giroux said, adding that the hospital is working with provincial officials in the event it needs to transfer patients to other facilities.

At a briefing on Tuesday, Kieran Moore, Ontario’s Chief Medical Officer of Health, said officials are watching the hospitalization rate in Sudbury, as well as the hard-hit cities of Sault Ste. Marie and Kingston. If the situation in those cities becomes much worse, officials will transfer patients from those centres to other parts of the province, Dr. Moore said.

Sudbury parent Angela Colizza said she and the families around her are being especially cautious with the recent surge in cases among the youngest cohort. Her daughter is in kindergarten and is not yet eligible for vaccines. Her daughter’s class was recently dismissed because of a COVID-19 exposure. The rapid tests in backpacks add another layer of protection, Ms. Colizza said.

“There’s always a little bit of anxiety with sending her to school especially given that she doesn’t have any protection from vaccination,” she said.

Ms. Quesnele said that if anything, she’d rather officials pause extracurricular activities than move children to a remote learning environment again this academic year.

“I just want to see schools stay open,” she said.

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