Thread by @NishaOttawa

1/It's the eve of provincial announcements on schools reopening for in-person instruction.

Households are under stress and experts are divided on whether schools are unicorns or infernos.

Everyone wants to do right by kids, who have borne so much throughout this pandemic.

2/As @AmyGreerKalisz, @AshTuite and I wrote in July, the most effective strategy in schools is to decrease community transmission.

In that context, superspreader events in schools rarely occurred in the Fall, and PH measures seemed to be effective. theglobeandmail.com/opinion/articl…

3/But local and global data are conflicted re: the role kids play in #SARSCoV2 transmission, with few studies involving comprehensive testing of asymptomatic high-risk contacts.

(recall: up to 50% of kids with COVID are asymptomatic, so symptom-based testing will miss cases).

4/This sets up a false dichotomy – are schools safe vs drivers of infection in the community?

It's likely somewhere between unicorns and infernos, but the risk calculus changes when disease rates are high and we rely on the same safety measures to avoid the "3Cs".

6/Individual measures (mask, distance, HH, outdoors) prevent spread if done consistently

But imagine a spark = anyone with COVID

High community rates
= more sparks in crowded, confined spaces with prolonged close contact (e.g. schools, LTC)
= more risk of fire and spread

7/And what of emerging data on the highly infectious variant B.1.1.7?

A school-related outbreak in the Netherlands may change our outlook for schools in affected communities:
46 sequenced samples (out of 123) from students and teachers had the variant. sciencemag.org/news/2021/01/n…

8/Currently, decision-makers are reviewing low-quality data to determine whether an essential service (that offers variable access to virtual learning) should reopen in a high-COVID-epi context.

economist.com/graphic-detail…

9/Some regions are ready to do so, others have overwhelmed #TestTraceIsolate systems.

@fordnation @ONThealth @ONeducation need to enhance supports to PHUs, school boards, businesses to ensure a STABLE return to in-person learning.

10/In high-transmission settings, it is imperative to have the capacity for comprehensive #TestTraceIsolateSupport
= reduce community spread + ensure the safety of in-person learning for staff, students and families.

Conditions for safe school reopening include the following:

11/PH units have been working closely with boards, labs, test and community partners to support schools.

But we need provincial multisectoral collaboration to consistently apply the above measures, beyond “simply” following PH guidance (esp #PaidSickLeave).

12/Education in a pandemic is not simple. Kids and adults are taking extraordinary action to make it work.

But a Go-No-Go approach is crude and inequitable.

Time for CLEAR ACTION on enhanced #TestTraceIsolateSupport measures.

Time to build resiliency and trust in the system.