Prachi Srivastava is an associate professor of education and global development at the University of Western Ontario. Gavin Yamey is a professor of global health and public policy at Duke University.
On Monday, Quebec became the first province to reopen schools, despite experiencing its first COVID-19 outbreak in a daycare facility last week. Thankfully, no one in the daycare has been hospitalized, but the Montreal Gazette reports 12 of the 27 children and four staff at the facility in Mascouche (about 40 kilometres outside Montreal) were infected.
The daycare outbreak should give us pause. Almost all governments worldwide closed schools as part of physical-distancing measures to curb the spread of COVID-19. Prolonged school closures have many risks – including educational deficits, potential exposure to abuse at home, and nutritional problems for children who rely on meals provided at school. Opening schools would free up more parents to return to work, a key part of restarting the economy. It’s no surprise that local and national governments have started discussing reopening elementary and secondary institutions.
But is Quebec’s reopening premature? How do we know when it’s safe to reopen?
The reality is: we don’t know. There are no well-designed, large studies that provide clear answers. The science so far has been frustratingly contradictory.
We know children can get infected. They can also get sick, although this is rare. There are also worrying reports of a new inflammatory disease in children potentially linked to COVID-19, resulting in hospitalizations in Montreal, New York, London and Paris. Three of the hospitalized children in New York have died.
One of the biggest concerns, however, is that children could silently spread the virus to each other and to their teachers, parents, and grandparents. At first, research on this question was reassuring. Studies found that COVID-19 was rare in children and that kids were unlikely to be transmitters.
But as the Mascouche daycare outbreak shows, schools and daycare facilities can in fact experience outbreaks, and some public health experts fear that school openings will spark surges in cases. In Wuhan and Shanghai, school closures helped to sharply reduce COVID-19 transmission. Studies in Switzerland and Germany found that when children are infected with the coronavirus, they shed levels of the virus equivalent to infected adults. The German researchers concluded: “Based on these results, we have to caution against an unlimited reopening of schools and kindergartens in the present situation. Children may be as infectious as adults.”
Given the unsettled science, the pragmatic way forward is to define conditions under which schools could be safely opened.
There are two key questions: What is happening with regard to the pandemic locally? And what measures should we put in place in schools to lower the risk if they reopen?
Governments should only consider reopening schools when COVID-19 is controlled locally. This means a sustained fall in new daily cases; ensuring all health workers have protective equipment; scaling up hospital capacity to deal with future COVID-19 outbreaks; and conducting widespread, efficient testing to identify new cases. If new cases are identified, they must be isolated quickly, and contact tracing must be thorough to test and quarantine people who have may have been infected.
If these conditions are met, schools must take steps to limit transmission between children, adults, and school staff. UNESCO, UNICEF, the World Bank, and the World Food Programme jointly laid out helpful guidance on risk reduction, including smaller class sizes, physical distancing, moving classes outside, hand-washing stations and staggering meal times.
Among the few governments worldwide that are reopening schools, some have controlled the spread of new COVID-19 cases. New Zealand and Denmark, for example, waited until transmission was tightly controlled before reopening.
But not all countries are being so cautious. France, for example, also reopened schools on Monday, given that the number of new daily cases is falling. But many French doctors and teachers are nervous, arguing the nation still lacks widespread testing, tracing and more careful planning.
This patchwork of strategies amounts to a giant natural experiment. We don’t know for sure whether school reopenings will spark a new wave of infections – or whether that wave can be controlled. But we do know the conditions that make reopening less risky.
In Quebec, at the epicentre of Canada’s struggle with COVID-19, few of those conditions exist. On May 1, Quebec recorded one of its largest number of new daily cases so far, at 1,110. That number has fallen since, but May 10 saw over 700 new cases and 142 new deaths, with over 38,000 confirmed cases in the province to date.
Testing is not meeting targets. The army was called in to provide emergency care in long-term care homes. Reopening schools in such an environment seems to be an awfully big risk to take.
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