Thread by @ASPphysician

The public are rightly concerned about class sizes, ventilation, and personal protective equipment in classrooms. They are all important, and govt should act. But they have directed attention, IMHO, away from what is much more important: keeping infections out of the classrooms.

We’ve all done our part to keep infection rates low in the province—that buys us a bit of time and will have prevented US-like scenarios. But we won’t be getting numbers lower any time soon with current plans. Unless we go all @IrfanDhalla and truly aim for elimination.

The highest forms of disease control are those that eliminate disease and those that keep disease out. Everything else is mitigation. Teachers should be advocating better surveillance more than class size if they want to stay safe. @tdsb @TCDSB @board_peel @DurhamDSB

If there were a broad, systematic surveillance strategy, we would have much better situational awareness. It is most important for elementary schools, where absenteeism is less likely to reflect circulating virus, but it’s important for all schools.

How do we surveil? Symptoms, we have seen, are a pretty poor method of surveillance. So we need to think of layers of surveillance:
1. Wastewater testing
2. Pooled samples—preferably weekly: test each class once/week. With probably 100K classes in the province, it’s doable.

3. Class/cohort testing for every positive test. (Getting all kids and teachers in class to stay home for 14d is insufficient to understand magnitude of problem: the index case may have acquired it from an asymptomatic spreader.)

4. Tracing positive community cases to schools: heightening (eg frequency) school surveillance whenever members of their community are infected.
5. Home testing when available
The @fordnation @Sflecce @celliottability govt can do this, but it requires collaborating and executing.

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