Amy Greer is a Canada Research Chair in Population Disease Modelling at the University of Guelph. Nisha Thampi is the Medical Director of Infection Prevention and Control at the Children’s Hospital of Eastern Ontario in Ottawa. Ashleigh Tuite is an assistant professor of epidemiology at the University of Toronto.
Labour Day is eight weeks away, and we don’t yet have a well-articulated plan for getting elementary school children back to class in Ontario.
There is no question that school attendance is critical for kids and families. The current hybrid proposal put forward by politicians rotates between in-person and online learning, so that children will only attend school part-time. The major impetus for the hybrid approach is to address issues of overcrowding that prevent adequate physical distancing in many classrooms. However, physical distancing is just one of many public health measures we have at our disposal. There are ways to facilitate a full-time return to elementary school for families that choose that option, while also ensuring the safety of our educational staff and communities.
We can borrow from the practices used in health care to plan a safe return to school. In hospitals, we use a layered infection prevention and control strategy, called the “hierarchy of hazard controls,” to prevent the spread of infection.
The first level of protection, considered the most effective at reducing infection risk, is elimination. We need to prevent COVID-19 from entering the school setting by screening children, staff and visitors, and by having minimal tolerance for illness. Employers can support this strategy by providing paid sick days and flexibility for parents to work remotely if children are not able to attend school. It will be difficult and imperfect, but keeping COVID-19 out of schools is our most effective line of defence.
Elimination also relies on decreasing community spread. As we move to less restrictive phases in our reopening plans, the actions we take during the summer to keep transmission low will enhance our chances of a successful return to school in the fall. We must continue the careful monitoring of disease activity through prompt testing, contact tracing and the isolation of cases and contacts. There must also be a willingness to re-evaluate our reopening priorities if disease activity shows signs of resurgence.
The second level of protection is in the use of “engineering controls,” which involves modifying the school environment to decrease COVID-19 exposure and improve compliance with public health measures. These modifications include keeping hand-hygiene tools accessible (such as sinks and hand-sanitizer dispensers) and making it easier to stay distanced from others (i.e. furniture placements). Existing space constraints have made the hybrid approach more palatable, yet some jurisdictions have recommended a “three-feet rule” between desks to increase the number of students who can be in a physical learning environment together at the same time.
The third level of protection is in the use of “administrative controls,” and involves changing the way we work in order to minimize transmission risk. These controls would include outdoor learning wherever possible, given that COVID-19 appears to transmit less readily outdoors. We need human resources to ensure appropriate cleaning frequency in schools, and education resources for families and staff on hand hygiene, symptom screening and cleaning procedures at home and at school.
The last level of control is to ensure the availability of personal protective equipment (PPE) to prevent the spread of respiratory droplets. If they are in an indoor setting where physical distancing is not possible, all students and staff should follow local public health directives regarding PPE use, to reduce the probability of transmission. Masks and/or face shields should be available to all staff and students who require them, to further reduce the potential for transmission within a school.
In summary, we need to protect our schools and communities this fall by following the hierarchy of hazard controls strategy. We need to re-engineer school spaces to support handwashing, physical distancing and smaller class sizes. We must develop policies and learning environments that minimize contact between staff and students, and provide PPE within schools when necessary.
Although no single measure alone is likely to be sufficient to eliminate the risk of COVID-19 transmission in schools, the impact of preventive strategies on disease transmission is expected to be multiplicative; a multilayered approach to preventing disease can help create an environment that minimizes risks while also ensuring all children have an opportunity to learn and thrive.
We also need to bring teachers, therapists, families and youth to the table to learn how to adapt and implement these strategies in the school setting. This will protect both those within the school walls, and our broader communities as well.
School closings have disproportionately affected our most vulnerable children, and we need to ensure that all children have access to learning, whatever form it takes in the coming year.
It is the duty of Ontario’s government to prioritize school reopening plans – and there is no time to waste. We must be bold in collectively meeting these challenges and investing in our students, who are, after all, our most important assets.
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