With 40 days to go to school in Ontario, when two million children would normally enter their new classrooms ready to learn, parents, teachers and education leaders all want to know: What’s the best way to restart safely?
As the science on COVID and children continues to evolve, five months after the onset of the global pandemic, there are reassuring signals that most children do not get very sick and severe cases are rare. And while we wait for clear answers about how children catch and transmit the disease, lessons learned from cities and countries that have kept children in school provide clues.
“Young children who are not infants tend to be milder; we have a lot of data on this around the world, ”said Dr Ari Bitnun, infectious disease physician at the Hospital for Sick Children.
“With regard to the acquisition and transmission of disease… there is a signal that children are less likely to be infected. But we don’t have the final answer. Only time we say it.
So far, evidence suggests that children do not appear to be super-spreaders of COVID-19 – a finding that may provide relief to some worried parents, said Dr Lindy Samson, infectious disease physician and chief of staff at the Children’s Hospital of Eastern Ontario (CHEO).
“It’s different from the flu or the common cold,” she said, noting that it was based on the best evidence available to date. “Young children are not the emitters of COVID in our community.”
It is less clear how much COVID-19 is transmitted by children, but there is new evidence that they are less likely to pass it to others than to adults, especially if they are under 10 years old.
A recent review of 33 studies from around the world of infections in children in school, daycare and home found that this was the clear message, from Scandinavia to Singapore.
Sarah Neil-Sztramko, assistant professor at McMaster University and one of the review’s leaders, said it got “a little more mixed” as children get older.
The outbreaks linked to the reopening of schools in Israel have recently made headlines. But the published reports her team reviewed came from high schools that opened during a heat wave, with air conditioning and no masks or physical distancing, she said.
There are limitations with “emerging data” from countries like South Korea, Australia and France, she added, such as small sample sizes. There are no published reports on Canadian schools and daycares yet. Only 13 of the studies have been peer reviewed, the gold standard among scientific papers, where they are independently reviewed by other experts in the field.
“But what comforts us is the consistency that we see in the studies,” said Neil-Sztramko. The results were the same regardless of the amount of community transmission. Some reports even came from the pre-lockdown, when no public health measures like masks were required in schools.
Outbreaks in schools and daycares were more likely to be attributed to adults, Neil-Sztramko added, as in a private school in Chile after a week of parent-teacher interviews. She hopes we can learn from some of the mistakes made elsewhere.
“That it’s not fair to reopen the game in free-to-play mode, we have to make sure that we have measures in place as well,” said Neil-Sztramko. “Children are not immune to epidemics, but with thoughtful measures in place I think it gives us more confidence that we can reopen schools safely.”
Before the province announced plans to reopen schools on Wednesday, a group of more than 30 medical and public health experts and led by the Hospital for Sick Children in Toronto released updated guidance on how to restart schools.
CHEO’s Samson, who is also a co-author of the paper, said the guidelines are based on the best evidence available to date and the recommendations will change with science.
“It’s an evolutionary response,” she says. “We need to help teachers, parents, children and youth understand this.”
Additionally, she added, the situation with COVID is different and will continue to be so in every region of the province and over time.
“What happens in Ottawa today will be different from what happens in Ottawa eight weeks from now, and similarly, what happens in Ottawa today is different from what happens in Thunder Bay.
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That’s why guidelines and medical evidence need to be interpreted and implemented at regional and local levels, with school boards and schools working closely with public health officials in their region, Samson said.
While parents will continue to worry about COVID-19 and children, Samson said there was clear evidence the pandemic and the closure of schools and public play spaces, rather than the virus. -even harm the health of children and young people.
“We need to make our next decisions on how to scale up or reopen things with that in mind,” she said. “Getting children back to school should be a priority. We all need to collectively take responsibility for keeping our communities COVID-free in every way possible to allow schools to open safely.
Dr Anna Banerji, an infectious disease specialist and associate professor of pediatrics at the Dalla Lana School of Public Health, said the chances of children themselves becoming very sick are low.
“When they are infected (they) appear to have a much milder infection, and they are more likely to be asymptomatic,” she says.
There have been reports of Multi-System Inflammatory Syndrome in children who have had COVID-19, a serious illness where parts of the body – like the heart and blood vessels – become inflamed, but it’s “very rare” .
According to data from the Public Health Agency of Canada, as of July 28, there has been only one death in a person under the age of 20 with COVID, out of thousands of cases.
This young girl may have died of something else, Banerji said, as officials announced in late June that she died from COVID, not COVID. The Chief Coroner of Ontario is leading an inquest to determine the role played by the disease.
The agency also reports that about 7 percent of total COVID-19 cases in Canada are under the age of 19.
Regarding transmission, Banerji notes that there is a precedent for children who contract, but do not spread, certain infectious diseases. They don’t really spread TB, she said, because when they cough, it’s not strong enough to disperse the germs of bacteria into the air like an adult would.
“The younger you are, the less likely you are to spill something,” she added.
“But I think the other thing is that these kids are not showing symptoms, so we’re probably not finding the source of the infection for some of these kids.