1/I have to believe this decision wasn't made lightly.

What I need to hear (and will actively support):

Resources will be committed to develop an integrated strategy for in-person instruction as a healthy, resilient workplace in Sept 2021

Why this is so important:
2/Schools offer an essential service to students

Many have benefitted from in-person instruction and stable access to clinical services as needed.

And more have benefitted when there have been additional educational supports (e.g. EAs)
We have seen investments for schools to be healthier workplaces for students

and for the education staff who are critical to their essential work.

But these measures haven't been consistently applied across communities, despite PHUs, education admin, staff, parents leaning in.
For healthier schools, there needs to be community-based measures:

- Vaccines and #CommunityImmunity for indirect benefits to younger kids

- #PaidSickLeave (to keep sick kids at home)

- intact #TestTraceIsolate systems

👆🏾 wrap-around supports for healthier schools
Measures at baseline that⬇️disruptions + ⬆️learning:

- Screening + isolation strategy for sick/exposed students/staff

- hand hygiene, cleaning

- Ventilation: outdoor ed, windows + indoor air quality, smaller class sizes

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:
Debates around safe vs unsafe schools have damaged trust in education, epi and PH.

We need
- transparency on this decision, given support to MOHs
- a plan to sustain resilience to infectious hazards for schools

This values kids/staff more than as monkeys in the middle

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More from @NishaOttawa

1 Jun
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.

BUT horizontal measures, like
Read 4 tweets
27 May
🧵Great interest in #OutdoorLearning in ON

It supports a positive dynamic btw health, wellbeing + education

My bias: also valuable for unparalleled air changes😉

Yet out-of-the-[school]-box models are more than desks outside (good start though!)

1/
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/ Image
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!):

3/ Image
Read 9 tweets
17 Feb
🧵 on asymptomatic testing in schools:

Testing is one of the tools in our toolbox of risk controls to keep schools open and safe for in-person learning.

Framework explained with @AmyGreerKalisz @AshTuite theglobeandmail.com/opinion/articl…
And in school guidance: sickkids.ca/en/news/archiv…
1/
COVID testing should prioritize the highest transmission risk groups
= symptomatic + asymptomatic high-risk contacts as identified by contact tracing

This relies on robust #TestTrace systems. But
2/
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/
Read 8 tweets
20 Jan
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).
Read 11 tweets
3 Sep 20
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.

So little is in her control these days.

3/7
Read 7 tweets
18 Jun 20
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.
Read 16 tweets

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