Kids

How will Ontario schools keep kids safe during the third wave?

It was sometime in August 2020, before the last reopening of schools in Ontario, that Sarah Liss became fixated with ventilation. Her older child goes to school in the Toronto District School Board, in the kind of building where students complain about the sweltering heat on warmer days. Only now she was worried about COVID.

With school boards and the province focusing on masks, cohorting and cleaning, Liss used her spare time researching another vital factor identified by health and science experts for slowing transmission: ventilation. Specifically, she began looking for solutions to get air purifiers into classrooms not only across the city, but the entire province.

She stumbled upon Danby, an appliance company based in Guelph, Ont. that makes portable high-efficiency particulate air (HEPA) purifiers. The CEO’s name rang a bell; Liss remembered an article in Toronto Life a few years ago about how the mild-mannered philanthropist quietly sponsored 200 Syrian refugees. Jim Estill sounded like someone who might have a creative solution. “He’s also an eccentric enough guy that he has a WordPress blog which includes his personal email address,” Liss adds.

She wrote him out of the blue explaining that schools needed help. He replied, and they began to brainstorm. Estill didn’t have enough units for every classroom in the province—about 65,000 according to a “guesstimate” Liss received from the advocacy group People for Education (she never got concrete numbers via more official avenues). But he said he could donate several hundred units. Another possibility, which Estill mentioned in passing, was that Danby might be able to produce enough units for every classroom by 2021, which he could sell at a reduced cost.

Liss took that information to her friend Roxanne Wright, who chairs the school’s parent council, and they reached out to the TDSB for next steps. It had the early makings of a success story, Liss says, “about a grassroots parent effort that wasn’t for a home school—and the power of sending a random email. But it was such a bummer. The TDSB bungled every piece of it.”

Liss and Wright’s experience raises questions about missed opportunities to make classrooms safer—questions that have become more urgent as the last cohorts of kids returned to in-person school this week, and warnings grow from health authorities of a disastrous third wave.

Experts appear to agree unanimously on the negative impact that missing out on school can have on a child’s physical and mental health. The question is whether the right mitigation measures are in place to ensure that kids can rejoin school safely—and remain there as the province continues to relax restrictions. Ontario has pledged enhanced safety measures: mandating masks for kids as young Grade 1—indoors and outdoors—and targeted asymptomatic testing. But will these measures be enough given the potential spread of new coronavirus variants spreading across parts of the country?

Not according to some experts. On Friday, Bradley Wouters, executive vice-president of science and research at the University Health Network and a senior scientist at Princess Margaret Cancer Centre, publicly declared via Twitter that he had pulled his kids from in-person learning. “Convinced it’s not safe to go back,” he wrote. Amy Greer, an epidemiologist at the University of Guelph, told CBC’s Front Burner podcast that her two kids, ages five and nine, will do virtual school, as they have since September: “It is the choice we made for our own situation.” And David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health tweeted Feb. 11: “If we’re going back to in-school learning in Ontario hotspots, time for the Ministry of Ed to get serious about ventilation in schools. We need CO2 monitors and HEPA filters in our classrooms. Students, teachers and communities deserve to be safe.”

It might have gone differently. Liss found herself reflecting on her own frustrating experience from last summer as she prepared to send her kids back to school. Liss is not an expert on air purifiers. She simply wanted to start a conversation between the TDSB and the CEO she’d found who was willing to help. But it took weeks for anyone at the under-resourced school board to return her emails. When she and Wright finally got a video meeting with the TDSB for Estill and themselves, the school board representatives didn’t show up. When they eventually connected the school board with Estill, TDSB’s business development department sent him a list of questions, such as whether an air purifier kills viruses like COVID-19—something that could have been answered with a simple Google search. (They do not; nor was anyone claiming they could. But there is some evidence they can help limit its spread.)

Dejected, Liss and Wright stepped back from the project she helped launch. They later heard about the result via a TDSB email blast in mid-October: Estill would provide the school board with a donation of 500 air purifiers. “It’s better than nothing,” Liss says. But it’s also disappointing, “when you know what could have been possible—if there had been any will at the board.”

The complications seemed inevitable. A donation was a simple matter; a TDSB purchase has to follow time-consuming bureaucratic procedures. Estill, for his part, didn’t push the idea of producing more units for schools because he didn’t want to “cloud the donation,” he says in an interview. His company’s motto is: “do the right thing”; he didn’t want any perception of doing otherwise. “If I donate air purifiers, it’s clear I’m donating them,” Estill adds. “Air purifiers were in shortage. We basically donated all we had in inventory.”

In the end, the units went to 37 schools that don’t have mechanical ventilation systems or HVAC—even though this is a reality for half of the TDSB’s nearly 600 schools.

Liss is acutely aware that had the TDSB been able to work out an arrangement with Estill last summer, there’s a chance every classroom in the city could have an air purifier by now. As it is, schools go back to in-class learning to a starkly different reality compared with September, with daily average case rates five times higher and more contagious variants of concern circulating in Ontario. She’s left to wonder just what has changed inside the classroom, and she’s not the only parent in that position.

In the Greater Toronto Area, “there’s really been no changes from when we were last open,” says Ryan Harper, acting president of the Peel branch for the Ontario Secondary School Teachers’ Federation. “We keep hearing: ‘Schools are safe. Schools are safe.’ I’m looking at the so-called enhanced measures and I don’t see any changes.”

The Peel School Board has expanded its masking policy in accordance with provincial guidelines and has a new self-screening framework; students must stay home if they have even one symptom of COVID-19. (This, of course, does not address asymptomatic cases, which also drive COVID’s spread.) With respect to HVAC systems, the school board says every classroom in their schools “have been reviewed and upgraded in some capacity.” Schools with mechanical systems, for example, now have upgraded air filters to above industry standards that will be changed more often and the ventilation system will have longer hours of operation. The board has also installed 969 portable air filtration units.

That works out, on average, less than four portable air filtration units per school. And classrooms, depending on their square footage, could need multiple units to cover the entire room.

Harper laments the lack of standards system-wide. “There should be a standard for what’s appropriate for ventilation in schools—and there’s not,” he says. “We just hear there’s improved ventilation, but what does that mean? Is it one device for one classroom somewhere so you can now say there’s improved ventilation?”

Even the most engaged parents find it difficult to get answers on what improvements have been made. Sarah Elton, a mother of two, joined the parent council for her kids’ school in September in hopes of helping with COVID-related concerns. Elton is an assistant professor at Ryerson University and the Dalla Lana school of public health and a health researcher. She recently attended a webinar with a participant from ASHRAE, an organization of engineers at the forefront of ventilation standards, where she learned a lot about the group’s recommendations to potentially reduce the spread of COVID aerosols in non-medical buildings, such as schools: ensure the relative humidity of the building is above 40 per cent, utilize portable air purifiers, add Ultraviolet Germicidal Irradiation (UVGI) devices where possible and keep the HVAC system running 24/7. (TDSB adjusted its mechanical systems to start running two hours before school starts, and run for two hours after school ends. Peel states it “increased hours of operation for the ventilation system.” )

Elton emailed the Superintendent of Education asking if any of these measures were in place at her kids’ school. She got no reply for a month. When she followed up, he thanked her for her work on parent council, adding that the school board planned to replace the windows at her kids’ school (which don’t open in most of the building) sometime in the spring or summer. He also pointed her to a TDSB website link with frequently asked questions on HEPA filters. “I got a pat-on-the-back email—it’s great that parents care so much—and I found that so patronizing and frustrating,” Elton says. “I received no indication they are doing anything on these widely circulated, easily available standards.”

The “they” in question includes the province. There is already evidence that Ontario’s ministry of education did not do everything it could to make classrooms safe; a Toronto Star report revealed that the province walked back plans for “substantial surveillance testing,” among other things. But school boards’ hands aren’t entirely tied to decisions made by the province on safety measures. The Toronto Catholic District School Board (TCDSB), in the same city, tested using plexiglass at desks for students in COVID hot spots. They also had a pilot project in the fall with outdoor tents at 10 schools, with classes rotating in and out throughout the day.

“A 100-year pandemic? This is the time to boldly go forward and try and see what works” based on the science,” says TCDSB trustee Norm Di Pasquale. The verdict on the Catholic school board’s interventions: the plexiglass desk shields proved annoying during the instructional day as they were hard to see through and sometimes fell off the desks. (They are also likely ineffective for curbing aerosol particles, a growing number of experts believe, since these behave more like cigarette smoke than like droplets.) But they were somewhat useful to offer a barrier of protection at lunch hour when students eat with their masks off. Meanwhile, the outdoor tents worked well, though they won’t be of much help in Canadian winters.

As for ventilation, “we’re studying the CO2 particles and air flow in our schools—and we’ll get that report back in a week to help us determine how to invest the ventilation funding from the government,” Di Pasquale says. Monitoring carbon dioxide levels doesn’t tell if COVID-19 aerosols are floating in the air, but CO2 levels can act as a proxy of sorts to measure how much exhaled air is in the room. This could prove especially valuable as evidence mounts that COVID-19 is airborne and can travel more than six feet.

Dividing a school into separate groups with only one cohort of students from each class on campus at a given time—be it alternating days or weeks—could also significantly reduce the both the likelihood of and size of a COVID outbreak, according to a recent study from Colour Health, a California-based health technology company. In primary schools, for example, “the probability of an outbreak infecting more than five per cent of the students plummets from nearly fifty percent with no cohorting to around three percent with weekly cohorting.” Couple this with regular randomized testing of students and teachers and the likelihood of an outbreak spreading widely is even lower.

The study also found that vaccinating teachers and staff could have a disproportionate protective effect with respect to outbreak in primary and secondary schools, though that remains a remote prospect in Ontario, which is still vaccinating high-risk residents of long-term care homes.

The country’s largest school board has not mandated such measures. The TDSB did say it has purchased an additional 4,000 air purifiers/HEPA filters for use in classrooms that don’t use mechanical ventilation, or have limited ability to provide fresh air. None of these units, incidentally, was purchased from Danby. Estill says he was open to responding to a tender if the board was purchasing more units, but he was unaware the board had done so until he was told by Maclean’s. A TDSB spokesperson told Maclean’s that the units they purchased service a larger area than those donated to the school board by Danby.

In any case, kids are now filing into classrooms across the city and the province. The effects of the latest shift remain to be seen. An Ontario simulation-study last fall by University of Toronto researchers found that most COVID cases in schools, after the first two months of classes, were the result of community transmission rather than transmission within the classroom. However, Montreal’s experience during the second wave was different.

By early November there were more outbreaks in schools than workplaces and the group with the highest COVID cases were children aged 10 to 19. Several experts, including the head of the Association des médecins microbiologistes-infectiologues du Québec, blamed transmission in schools rather than the community for the city’s climbing numbers. A study last month conducted by researchers at the Universite de Montreal, George Washington University and CovidEcolesQuebec.org likewise concluded that schools are now driving COVID spread in the community, rather than the other way around. “Right now limiting in-person schooling as much as possible would actually be the right solution,” Simona Bignmami, one of the study’s authors, told Global News, although if schools stay open, the authors strongly recommend measures such as good ventilation and asymptomatic testing.

Children are less likely to show serious symptoms of COVID, thankfully, but that can complicate data collection if they aren’t being tested while asymptomatic. Nor are the effects of the new variants entirely known; early studies suggest that while the B117 variant is still less contagious among children, compared to adults, it could still be around 50 per cent more transmissible among both children and adults.

Children weren’t considered at risk from COVID during the first and second waves, but health experts in Israel, where the U.K. variant has been circulating since December, reportedly revised that assessment after an increase in cases and hospitalizations among children and teens, according to the Jerusalem Post. Some 50,000 young people tested positive in January alone, and the country has seen a troubling new phenomenon: kids with “long COVID,” or post-infection symptoms such as shortness of breath, fatigue, headaches and heart palpitations. Many had only mild cases of COVID. While Israel has led the world for vaccination rates among adults, the country also recently opened its first intensive care unit specifically for children with COVID.

With daily case counts and death rates falling across most of Canada, Brooks Fallis, a critical care doctor with the William Osler Health system in the Greater Toronto Area wrote in the Globe and Mail that “reopening of schools and economies without meaningful improvements in surveillance or containment” could lead the country into a third wave.

The subject of school transmission came up last week in Newfoundland and Labrador, where authorities cancelled in-person voting a day before what would have been Election Day. The province’s Chief Medical Officer of Health attributed a huge spike in COVID to the more contagious B117 variant of the coronavirus. “We certainly had significant spread this weekend—and it spread quite easily and quite rapidly through the high school,” Dr. Janice Fitzgerald explained at a Friday news conference. “This certainly confirms what a lot of us were perhaps suspecting, but not really wanting to admit.”

The same variant, first detected in the U.K., has spread to students across at least seven Alberta classrooms, with the first case of in-school transmission reported days ago. Four Montreal schools have temporarily closed their doors amid outbreaks, including one with the variant. And one of the variants of concern has also shown up in a school in Kitchener, Ont., which opened to in-person learning on Feb. 8.

All of this has made parents like Elton feel deeply conflicted about the decision to send their kids back to school. Elton points out her children’s schools are no safer than before, but she also had to take into consideration their education and mental health. “It blows my mind that we’re in a position where we’re heading back to school with new variants that are highly infectious and appear to be circulating in our community, and we don’t even know what’s being done through basic measures—like using the school’s humidifiers.”

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