It’s been an intense Fall for pediatric health systems across the Northern hemisphere.

We describe what happened at @CHEO for kids admitted with lab-confirmed resp viral infections up to Dec 10, compared to previous years.

medrxiv.org/content/10.110…

🧵 on our experiences:

/1 CHEO Context:
Catchment 500K+ kids

Sole pediatric tertiary care centre in Eastern ON
Also serving kids from western QC, northern ON, Nunavut

Adult hospitals in Ottawa don’t have peds beds but are taking critically ill teens after recent provincial directive
2/

People talking about babies needing to get infections [to build immunity] have clearly not spent enough time around babies who've survived infections to understand this is NOT a good idea.

thread/

https://twitter.com/acweyand/status/1591830844364279813

RSV is a great/terrible example of why infection in infancy is not a good idea

Highest admit rate if <6mos

Increased risk of sleep-disordered breathing, asthma/reactive airways with future infections

Consequences persist beyond 12m after hospitalization

And reinfection likely

The news doesn't quite capture the intensity of work at CHEO, and sense of futility as we get more kids admitted with RSV, rhino, flu, bacterial pneumonia, asthma.

I understand that the signal for public health action is when the acute care system is in crisis.
1/ What will it take for peds? We've maxed ED capacity, canceled surgeries, increased nursing and MD assignments.

Cannot redeploy more staff without a PH order, so relying on colleagues to volunteer.

Cannot create more isolation beds. Will not bring sick staff to work (good).
2/

This is hard news for many families and staff, for school administration and PHUs who have tried to keep school communities safer during the pandemic.

As much as we'd all like to "return to normal", we have to acknowledge:

https://twitter.com/krushowy/status/1501370651457859588

1. While there seems to be tolerance for COVID to spread in the community, we should continue to hold certain institutions to higher standards, including hospitals and schools.

They provide essential services as spaces for learning, child care, therapy and development.

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/

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:

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:

https://twitter.com/DocDominik/status/1400100886345568258

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)

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

🧵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!)

https://twitter.com/NishaOttawa/status/1273446268702986241?s=20

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/

🧵 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/

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…

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

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.

I was asked by FB friends to share this post - thoughts on #covid19Canada from #IPAC and #frontlinemom. Breaking it down into a thread, recognizing the challenge to be timely and relevant (and brief?!) in this changing period... 1/n There remains one constant guiding principle = WASH YOUR HANDS. My favourite message from impressive BC public health officer Dr. Bonnie Henry: "wash your hands like you just cut up a bunch of jalapeños and need to take your contacts out." Yes, yes, protect your eyeballs! (2/n)