(1/18) A couple of people have drawn my attention to the guidance on school reopening recently released by The Hospital for Sick Children in Toronto.
I have some serious concerns about the document.
sickkids.ca/PDFs/About-Sic…
I have some serious concerns about the document.
sickkids.ca/PDFs/About-Sic…
(2/18) I don't have time to perform a complete review, but I want to highlight some serious problems which cast doubt on the recommendations.
(3/18) First, the authors state that "evidence is mounting that children may be less susceptible to SARS-CoV-2 infection and may be less likely to transmit the virus to others."
They provide two references to support this statement.
They provide two references to support this statement.
(4/18) The first is a peculiar review by Jonas Ludvigsson. In it, Ludvigsson writes: "So far there have been no reports of COVID-19 outbreaks in Swedish schools."
And yet, school outbreaks have occurred in Sweden, including one in which a teacher died.
And yet, school outbreaks have occurred in Sweden, including one in which a teacher died.
(5/18) The second piece of evidence is a model. It's quite a nice model, but a model is only as good as the data and assumptions it is based on. If they are inaccurate, the model will be too.
(6/18) Which brings me to those assumptions.
I've reported multiple studies which show no difference in the proportion of adults and children infected.
You can find them here, along with lots of other interesting data about children and the virus:
I've reported multiple studies which show no difference in the proportion of adults and children infected.
You can find them here, along with lots of other interesting data about children and the virus:
(7/18) To me, this suggests that environmental and social factors are the major determinants of whether children will be infected.
(8/18) When reading a study, questions you should ask include:
➡️ How was the virus introduced into the region, and among whom did it first spread?
➡️ How much community transmission was there at the time?
➡️ Were schools closed?
➡️ Were cases promptly quarantined?
➡️ How was the virus introduced into the region, and among whom did it first spread?
➡️ How much community transmission was there at the time?
➡️ Were schools closed?
➡️ Were cases promptly quarantined?
(9/18) Back to the report.
Next, the authors mention that the inflammatory syndrome which has emerged in children (the Kawasaki-like illness) is "relatively rare and is generally treatable."
Next, the authors mention that the inflammatory syndrome which has emerged in children (the Kawasaki-like illness) is "relatively rare and is generally treatable."
(10/18) Well, yes, it is rare in relative terms, but it won't be in absolute terms if enough children are infected.
Let's also not forget that a few children have died, and others will need ongoing follow-up to monitor for cardiovascular problems.
Let's also not forget that a few children have died, and others will need ongoing follow-up to monitor for cardiovascular problems.
(11/18) The authors go on to state that measures to mitigate the spread of the virus have "significant adverse health and welfare consequences for children."
I agree with this.
But a balance must be struck between harms. Schools do need to open, but safely.
I agree with this.
But a balance must be struck between harms. Schools do need to open, but safely.
(12/18) The authors then go on to list various measures which could reduce the risks associated with reopening schools.
(13/18) Screening to prevent symptomatic students from attending school is recommended, but they also recommend that "parents and caregivers be empowered by placing the responsibility for screening on the parents/caregiver."
Good luck enforcing that.
Good luck enforcing that.
(14/18) There's also some discussion about face masks; the authors don't recommend them. It's true that masks are a complicated issue, one that I can't do justice to in this thread.
(15/18) But I can't let this statement by the authors slip by:
"There is a lack of evidence that wearing a face mask prevents SARS-CoV-2 transmission in children."
As far as I know, no one has studied this. This is extremely misleading. (I also strongly suspect masks do help).
"There is a lack of evidence that wearing a face mask prevents SARS-CoV-2 transmission in children."
As far as I know, no one has studied this. This is extremely misleading. (I also strongly suspect masks do help).
(16/18) If the rest of the report is of a similar quality, then I’m not filled with confidence.
(17/18) Don't get me wrong. Schools can't stay closed forever.
But they must reopen in a manner which is safe for children, teachers, and the wider community.
Necessary precautions must be taken. This document doesn't identify enough of them.
But they must reopen in a manner which is safe for children, teachers, and the wider community.
Necessary precautions must be taken. This document doesn't identify enough of them.
(18/18) For another perspective, see @NishaOttawa, who I think has rightly identified that this document is a starting point for stakeholder discussion.
I'm going to add one final point which often seems to be overlooked.
The risk that children might bring the virus home from school and transmit it to family members must not be ignored. What harms (including psychological), might be associated with that?
The risk that children might bring the virus home from school and transmit it to family members must not be ignored. What harms (including psychological), might be associated with that?
One more very important point.
We should build testing and contact tracing infrastructure to reduce (and ideally eliminate) community transmission.
South Korea also provides an excellent model for school safety. The pictures really are worth 1,000 words:
washingtonpost.com/education/2020…
We should build testing and contact tracing infrastructure to reduce (and ideally eliminate) community transmission.
South Korea also provides an excellent model for school safety. The pictures really are worth 1,000 words:
washingtonpost.com/education/2020…
