And TEMPORIZING measures to support learning when community infection rates⬆️
We have evidence-informed metrics + tools:
-cohorting students/staff
-blended learning
-masking for source control
-broader TTI
-activity restrictions...
*3rd image👇🏾 (current state) is not acceptable
While the evidence has not changed, the "fébrilité" around returning to in-person instruction is more palpable than ever.
Education vs economy.
Patio vs principles.
I appreciated @petrosoniak's take on complexities in decision-making back in January:
1/As we close a 2nd abysmal school year, this comprehensive report explores challenges in ON schools.
Fundamentally, in high-epi context, more introductions into school
= increased risk of spread in school and into community without additional measures thestar.com/news/investiga…
2/Testing + symptom screening act as red light
= prevent introductions
BUT an individual in school during their infectious period will still lead to cohort dismissal
👆🏾 why #COVIDZero in community + health/safety measures in school needed for stable in-person instruction
3/QC kept schools open + shut down gatherings elsewhere for months; still saw cohort dismissals in high-epi settings ~GTA
Screening is a vertical strategy that seeks out 1 specific pestilence. It's hard to find cases that cannot afford to be found.
Let's see where #OutdoorLearning falls within the hierarchy of [infectious] hazard controls
Ventilation is usually considered an engineering control
But outdoor learning changes the way students and staff work, so one could argue it's an administrative control too #twofer 2/
BENEFITS of #OutdoorLearning include: 1) higher ventilation 2) improved air quality
= better mental/physical health outcomes AND reduced infection risk
Evidence in table 👇🏾
(from a useful paper in @DavidElfstrom's useful🧵- suggest reading both!):
This approach does NOT necessarily detect large # asymptomatic/symptomatic individuals (see serology studies) esp if insufficient resources to follow-up cases and trace contacts.
What can asymptomatic screening (with rapid Ag or PCR test) ADD?
3/
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).
It's the eve of a new school year. The younger one is excited. He's read "la liste des fournitures scolaires" and packed shield, headphones, sanitizer, pencil case, tissue box.
Jumps into bed, asleep within minutes.
As I tuck in the older one, she whispers: "I'm nervous." 1/7
I'm nervous too.
"What are you nervous about?"
I'm expecting the usual - new school, people, routines - and reassure her. As a local school, she'll easily develop friendships in our neighborhood, which she missed in previous years.
"What about COVID? Will it be there?"
2/7
Her fears are about transmission, as source + as contact.
About bringing it home. About sharing with friends.
And about getting something WAY worse than cooties.
Maybe even at the level of poopy pants, but I don't explore this.
1/ @SickKidsNews released guidance today about school reopening. Colleagues, mentors +caregiver advocates among co-authors. I was not involved in its development, and can appreciate concerns raised re: content and comprehensiveness. A few thoughts as peds + ID/IPAC physician:
@SickKidsNews 2/ This was a summary of current published evidence + #IPAC principles to consider w/school reopening, and would've benefited from ON-specific data - BUT we couldn't routinely test sx'ic kids for MONTHS unless they were admitted. Huge gap in knowledge of provincial epi.
@SickKidsNews 3/ Clinicians are trusted sources of knowledge + community partnership; we have a role in knowledge translation. Need scientists at table to dissect real-time data + model impact of strategies (screening/cohorting/shielding) to inform dynamic approach ie responsive to local epi.