Impressed at how quickly the masking recs in the ON schools guidance were taken out of context and misinterpreted. 🧵

covid19-sciencetable.ca/sciencebrief/s…

TL;DR:

1. Masking is important + effective

2. We recommend aligning school practices with PH guidance on masking indoors

1/8
cdc.gov/coronavirus/20…

We read this 👆 carefully when it came out 10d ago and compared with our guidance.

Aside - found its vent/filtration section lacking in strategies and details.

(Our stakeholders said they wanted a roadmap.
So we built that into the recs 👇)

2/
Back to CDC doc:
"Masks should be worn indoors by all individuals (age 2+) who are not fully vaccinated"

"Not fully vaccinated" i.e. guidance based on individual vaccine status?

How would this work for 12-17 now? 5-11yo later?
How to not discriminate against unvaxxed?

3/
AAP today:

"recommendation that everyone older than age 2 wear masks, regardless of vaccination status"
services.aap.org/en/news-room/n…

No surprise, and good that vaccine status is removed

4/
Also:

"Many schools will not have a system to monitor vaccine status of students, teachers and staff, and some communities overall have low vaccination uptake where the virus may be circulating more prominently"

The AAP guidance aligns with what's set in our ON guidance.

5/
We recommended masking in elementary grades if there's more circulating virus in community. Older kids follow PH guidance for indoors

C.f. a low-risk scenario, where you've got minimal circulating virus + minimal societal restrictions (likely with high vaccine uptake)

6/
Low risk scenario defined as
1. minimal disease burden
2. reproduction number < 1 (i.e. not epidemic growth)

This is the looking-ahead scenario.

Not the here-and-now scenario.

Maybe the near-future scenario as we lift restrictions
#ComunityImmunity and #TTI critical here
7/
Again, masking is important and effective. A well-fitted mask that controls droplets is considered an engineering control!

Schools would - at minimum - follow PH guidance:
If masking indoors among adults, then mask in schools among kids

(all contributors aligned on this)
8/fin

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More from @NishaOttawa

19 Jul
1/Our back-to-school guidance for schools in Ontario is out!
This framework reflects a year’s worth of evidence, lived experience, and tremendous stakeholder engagement.
covid19-sciencetable.ca/sciencebrief/s…
2/Here’s what the brief touches on:
3/Our group came at this with the shared perspective:

School is the “essential work” of children. Educators + school staff are critical to students’ work.

We have heard from educators, administrators, clinicians and child health advocates how turbulent this year has been.
Read 12 tweets
2 Jun
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.
Read 8 tweets
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

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