The day before their two young kids head back to elementary school, Dr. Noah Ivers and his wife will go for a family walk in their Toronto neighbourhood.
They’ll reminisce over summer memories. They’ll stop for ice cream. And they’ll have a conversation about how to manage COVID-19 risks in the classroom.
“We’ll talk about the fact that COVID is not gone, and that we anticipate a lot more viral infections swirling around in classrooms, that there are steps they can take, and then we’ll stop and ask them how does knowing all that make them feel,” says Ivers, a family physician at Women’s College Hospital.
“I suspect one of our children — if not both — will admit to being a little worried.”
Ivers, whose wife is also a doctor, says they want to help their kids navigate their back-to-school emotions while also outlining the risks and realities of this third pandemic September.
“I don’t want them to worry; that doesn’t do anybody any good. But I want them to have some amount of situational awareness and some sense of what is and isn’t in their power, what they can and can’t control, and feel empowered to control those things,” he says, adding the discussion will centre on wearing masks, how to identify risky COVID spaces and why their vaccines will likely keep them from getting really sick.
Ivers’ family is one of many figuring out their COVID strategies as kids head back into classrooms.
The government’s announcement this week that it was scrapping the five-day quarantine for those infected with COVID, combined with public health advice and previously published science table recommendations on the return to school, have left a huge amount of information for parents to parse.
The Star reached out to family doctors, pediatricians, infectious disease specialists, epidemiologists and science communicators — many of whom are parents themselves — for their thoughts on how to make the return to school as smooth as possible.
How does the COVID-19 landscape this September differ from last year?
Dr. Fahad Razak, former scientific director of the Ontario COVID-19 Science Advisory Table, says that viral levels are markedly higher this September compared to the start of school last year, meaning there is significantly more risk of spread as people move indoors.
Complicating the situation, says Dr. Nili Kaplan-Myrth, a family physician in Ottawa, is that Ontario currently has no mask or testing requirements, no contact tracing and, now, minimal isolation for those infected.
“We’ve basically let go of all the tools that we have. Instead, what we’ve got is a situation in which we know that COVID rates are high in the community and we’re sending children back into classrooms,” Kaplan-Myrth says. “Now, it’s just like a perfect storm.”
However, this September, children under the age of five are able to start school with at least one dose of vaccine, and third doses for children age five to 11 are now available. This means “many children heading back to school this fall have an additional layer of security they did not have last September,” says Sabina Vohra-Miller, founder of the website Unambiguous Science, a resource for easy-to-understand information on everything COVID.
This is echoed by Dr. Isaac Bogoch, an infectious diseases specialist at University Health Network, who points out there are higher levels of immunity amongst school-age kids through vaccination — and through recovery from infection — after the spring and summer COVID waves.
“From an immunity standpoint, there will be more people returning who have had evidence of either a recent infection and recovery from that or recent vaccination,” he says.
Should my child wear a mask in school this fall?
This will be the first full term since the start of the pandemic without mandates requiring students to wear masks in classrooms. Instead, public health advice and guidance from a recent Ontario science advisory table report say schools should be “mask friendly” spaces.
Many experts who spoke to the Star say they will continue to wear a mask in crowded indoor places — and that they are encouraging their children to do the same at school.
“That’s what I would recommend from a scientific perspective and also what I will be recommending to my kids,” says Razak. “But I accept that my kids may not follow this and will do my best as a parent; in the end, what else can you do?”
Dr. Peter Azzopardi, corporate chief and medical director of pediatrics at Scarborough Health Network, says most physicians and “certainly most pediatricians” are still “very much in favour of using masks in indoor spaces when they are crowded or poorly ventilated,” which include not just schools but other places where children and families gather.
This is especially true when it comes to children at higher risk of severe COVID infection, or for students and staff who have a vulnerable family member at home, he says.
“In general, our classrooms are going to be healthier if staff and students are wearing a mask.”
There are many valid reasons staff and students may choose to wear masks, even outside of COVID surges, says Dr. Nisha Thampi, an infectious disease pediatrician at CHEO, a pediatric health-care and research centre in Ottawa.
“They may be concerned about getting infected themselves, concerned about getting infected and spreading the infection to vulnerable people … concerned about getting sick impacting their ability to go to school or their family’s ability to go to work.”
Bogoch agrees that it makes sense to wear a mask indoors to reduce your individual risk of COVID. “Be it a school, be it a movie theatre, be it a sports venue: doesn’t matter,” he says. “If it’s an indoor venue, that’s where the vast majority of COVID is transmitted and you can reduce your individual risk of getting this by putting on a mask.”
How do I talk to my kids about this, if their friends aren’t wearing masks?
It can be similar, says Ivers, to how parents talk to their kids about any other kinds of risky behaviour. He says his approach is to talk about how different families have different rules for inside and outside the home.
Vohra-Miller says what has worked in her household is to talk about masking with her child frequently.
“We explain why we mask — to protect ourselves, to protect our immunocompromised and aging family members, and to protect our community,” she says. “Engaging your child in these discussions and explaining the rationale for wearing a mask gives children the agency and empowers them to advocate for their own safety.”
Thampi says it’s important for school leaders to set the tone early that schools are mask-friendly, making it clear the choice to mask needs to be respected and that inappropriate behaviour around masking won’t be tolerated. People need to be reminded that someone choosing to wear a mask “is a decision they’ve made to protect their community or themselves, and we should respect that.”
Children six months and older are now eligible for a COVID vaccine, including the newly announced boosters for kids age five to 11. Just what are the benefits of COVID vaccines heading into this school year?
Each of the experts who spoke to the Star say the evidence is sound, robust and clear: COVID vaccines are safe, effective and lower children’s risk of getting severely sick with the virus. And they encourage parents to keep their kids up to date on COVID vaccines, including boosters.
“We know vaccination works,” says Azzopardi. “We know it cuts down on infection rates, it cuts down on the number of symptoms you have when you do get infected, it cuts down on rates of hospitalization from this virus, and it cuts down on ICU admissions.”
As well, emerging data suggests vaccines can reduce the risk of “downstream issues” that arise from a COVID infection, including multisystem inflammatory syndrome of children, or MIS-C, and long COVID, says Vohra-Miller.
While she understands some parents may still be hesitant to have their kids vaccinated against COVID because “as parents, we all take the responsibility of keeping our child safe and protected very seriously,” Vohra-Miller says it is “reassuring that we now have several years worth of safety data on the mRNA vaccines and billions of people worldwide have been given these vaccines safely.”
Even if kids have already had COVID, Ivers encourages parents to get their child vaccinated because data shows immunity derived from vaccines provides greater protection against severe outcomes.
“That’s what I tell my family members, my patients, and I absolutely immunize my own kids,” he says.
Each expert who spoke to the Star recommended those with COVID vaccine questions talk to their health-care provider and go to trusted resources, such as those offered by the Hospital for Sick Children or the VaxFacts Clinic at the Scarborough Health Network.
The symptoms of COVID, the common cold and the flu can all be similar. What should you do if your child is sick but you’re not sure what illness they have?
COVID, the common cold and the flu are all infectious respiratory viruses, and any symptoms should trigger parents to keep their children home if possible, Razak notes.
“This could be an extremely challenging fall and winter because of not only COVID-19, but also other respiratory viruses, and we need to do what we can to reduce spread,” he says.
Colin Furness, an infection control epidemiologist at the University of Toronto, recommends that until there is a good understanding of Canada’s flu season you should assume your child has COVID, particularly if it starts as a sore throat and cough.
“Isolate them at home, use a rapid test on the fifth day of symptoms, not before, and be sure to swab the back of the throat and cheeks, then the nose,” he says.
What can individual schools and teachers do to help lower COVID risk in their classrooms?
In addition to public health recommendations for schools, which include guidance on hand hygiene, respiratory etiquette and ventilation, among other things, there are other practical steps schools and teachers can take.
These include creating a cross-breeze by opening windows, using portable HEPA filters in classrooms, and finding ways to take students outside for lessons and outdoor lunches, Furness says.
“Teachers also do model ideals for their students, who see them as role models,” he says.
“Bring a portable CO2 detector to school and tell your colleagues and principal what the air quality is like in your class (good or bad). Bringing air management and mask wearing on to people’s minds by talking about them may get people thinking and behaving more safely.”
The province has detailed guidance on ventilation in schools, including having one HEPA filter in all classrooms and other learning environments in schools without mechanical ventilation.
“In addition,” Vohra-Miller says, “schools can recommend children wear masks indoors, eat lunches either outside when the weather is good, or indoors in smaller cohorts and give out Rapid Antigen Tests to be used periodically.”
Extracurricular activities are returning to school this fall. Are there any you recommend children avoid or are there things parents can do to help lower risk?
Furness suggests avoiding indoor choirs altogether, as well as school bands with woodwind instruments, such as clarinets. “And I say this as someone whose adolescent sense of confidence was entirely derived from wind ensemble participation.”
Likewise, Kaplan-Myrth suggests schools introduce string programs if they haven’t already.
“I think musical education is extremely important, but also I think this is where maybe it’s a really great time to say, ‘Instead of band, let’s make it string instruments,’” she says. “It doesn’t mean that you can’t have music programs. It just means you have to be more creative.”
As for sports, Kaplan-Myrth recommends outdoor activities. But if it’s a sport that must be played inside “then you have to require masks.”
“I’ve seen too many of my patients who are in hockey leagues and (other indoor sports), and the whole team gets COVID,” she says.
Ivers encourages parents to have some situational awareness, especially if everyone seems to be coming down with something.
“Maybe it’s not the right time to be in a room with no ventilation and tons of people and no masks, like in hockey dressing rooms,” he says. “On the other hand, I desperately want my kids to be able to have play dates, and to have those inside as the season changes, because that’s how they develop their tight friendships that they need … finding as safe a way as possible for that to happen is, I think, necessary.”
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