The Ontario public health units where thousands of students will return to in-person learning next week would fall under the higher or highest risk categories for school transmission of COVID-19, according to thresholds set by the U.S. Centers for Disease Control and Prevention.
On Feb. 8, students in 13 more public health units will join those already back in the classroom, Education Minister Stephen Lecce announced Wednesday, bringing the total number of health regions with reopened schools to 31. Schools in Toronto, Peel and York will remain closed until Feb. 16, after the Family Day long weekend.
A Star analysis of population-adjusted COVID-19 infection rates over the last two weeks finds that 24 of Ontario’s 34 public health units fall within the CDC’s two highest categories for risk of transmission in schools.
“The problem we have is that we don’t understand transmission in schools,” said Colin Furness, an infection control epidemiologist at the University of Toronto. “If we don’t collect data and measure it ourselves, we’re not going to know. And that’s the crime.”
Furness said he thinks schools should return but only with universal testing.
“You show up, you get tested and if you don’t get a phone call you’re back at school the next day. It’s very simple,” he said. “It does two things: it opens schools and it also identifies community cases of COVID. Every kid you find who’s positive, you also find a family who’s positive.”
The CDC, the United States’ national health protection agency, breaks down school transmission risk into five categories according to the number of new cases per 100,000 people within the last 14 days in the surrounding community. Any number below 20 is considered lower or lowest risk. Twenty to 50 cases is considered moderate risk. Anything between 50 and 200 is labelled higher risk. More than 200 cases is considered the highest risk of transmission.
The agency notes that its transmission risk framework is guidance only and that it is up to individual jurisdictions to decide the most appropriate indicators to use when deciding whether to open or close schools. The agency recommends using the number of new cases per 100,000 people in the past 14 days and/or the percentage of tests that come back positive in the same time period, as well as the school’s ability to follow strategies to reduce the spread, such as the use of masks, cleaning, and local contact tracing.
Ontario’s chief medical officer of health, Dr. David Williams, said earlier this week that there is “not an exact number” the province is relying on when deciding whether to reopen schools but with weekly cases in the 100 to 150 per 100,000 people range, reopening could occur with the “proper checks and balances.”
Asked about thresholds for reopening at a Wednesday press conference, Williams said that, as in the fall, schools will be closed and opened based on investigations of local health units “not on a number matrix.”
Lecce added that the government has consulted with school boards and local health units, and has put “elevated and enhanced measures in place,” such as the capacity for rapid testing and stricter screening requirements.
Since the lockdown and stay at home order, “we have seen a consistent decline in community transmission,” he told reporters.
The public health regions that fall under the CDC’s highest risk category are Toronto, Peel, Niagara, Windsor-Essex and York. Two of those, Niagara and Windsor-Essex, are among those in which schools will reopen on Feb. 8. All 13 of the public health units with schools returning next week fall into the CDC’s higher or highest risk categories.
As of Wednesday morning, Ontario had recorded 7,392 school-related cases of COVID-19 to date, including 5,167 among students and 1,107 among staff. A further 1,118 cases were among “individuals not identified.” There are currently 42 schools in the province with a reported case.
A recent Star story highlighted how Ontario could see close to 4,000 new cases per day by the end of March if a new variant of the virus takes root in the population.
Ontario does not have a transparent framework with benchmarks for when schools should reopen or close. Many U.S. cities and states have set clear thresholds for schools, using indicators such as weekly cases per 100,000 or positivity rates. But these differ widely between jurisdictions, as officials weigh the delicate balance of safety with the importance of schools to parents, children and society.
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In Idaho, for example, the governor has been criticized for saying schools must stay open unless the 14-day per cent positivity in a district’s home county is over 15 per cent.
New York City schools closed this fall as the city as a whole reached a 3 per cent positive test rate, even as restaurants remained open. However, schools partially reopened less than three weeks later after an outcry.
In addition to the CDC guidance, Harvard University’s Global Health Institute has also weighed in, putting the highest risk level at more than 25 daily new cases per 100,000 people.
Targets like this “are useful if they’re tied to meaningful actions,” said Ashleigh Tuite, an epidemiologist and assistant professor at the University of Toronto, in an email.
When community transmission is higher there should be additional measures in place to reduce spread, such as improved ventilation, smaller class sizes, rapid case management and contact tracing when cases are detected, and access to rapid testing, she said.
“We want to open schools AND keep schools open,” she added.
Dr. Anna Banerji, an infectious disease specialist at the Dalla Lana School of Public Health, said it “could be” risky to open schools now. If cases start to spike again, it will be more clear.
“To me the bottom line is, it’s difficult, it’s a hard balance to find,” she said, adding she acknowledges the mental health impacts on kids and the stress many parents are under right now. “They need transparency and they need to feel that the government is listening.”
Jessica Lyons, of the Ontario Parent Action Network, does not feel that it is.
Hearing that most of the province’s health unit would be considered under the CDC framework makes her “absolutely even more concerned,” she said.
“It also makes me really angry that we’re going another day where we haven’t heard about paid sick days.”
Guidance in Ontario similar to that provided in the CDC framework would be “respectful and it would be transparent,” she said. But the case numbers are “just going to start exploding again” without safety measures in place, she said.
The numbers need to be low enough so that there’s the capacity to do effective contact tracing and testing, and sick days need to be available, instead of “dragging the province through these chaotic openings and closings that are sort of last minute without good scientific rationale,” Lyons said.
“This is just not right, and people are desperate for schools to reopen, because we’re being made to be desperate.”
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: email@example.com
May Warren is a Toronto-based breaking news reporter for the Star. Follow her on Twitter: @maywarren11
Ed Tubb is an assignment editor and a contributor focused on crime and justice for the Star. He is based in Toronto. Follow him on Twitter: @edtubb
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