This fall, we once again begin a school year during a pandemic. While we have learned many important facts about COVID-19 and how to limit its spread, new forms of concern, and especially the spread of the delta variant, raise questions about sending children to school.
Parents, policy-makers and school administrators are concerned about how society can best make choices, correct interventions, and improve physical and mental health during individual learning for Class 12 children from kindergarten. can increase the odds of staying healthy.
With no vaccines yet approved for children under the age of 12, it will be important to make a balanced decision and be based on local epidemiology and vaccination coverage.
1. How has the SARS-CoV-2 variant spread in schools?
Research suggests that transmission in schools depends on the level of community transmission.
Some schools in Canada remained open even after new forms were discovered and introduced.
Only the United Kingdom has good data on transmission to schools while the delta version was the dominant strain in circulation.
Read more: Masks, ventilation, vaccinations: 3 ways to protect our kids from the delta variant
Infection with the delta variant was detected in British students, but this did not increase the number of cases. Only 0.27 percent of primary school pupils tested positive, compared to about one percent in the winter period.
In Quebec, where some of our epidemiological research is based, 94 percent of schools reported cases by April 2021.
An overview of global studies (not all were peer-reviewed), where data was collected after January 2021, suggests that there is evidence of transmission in schools and daycares worldwide. However, transmission remained limited under a wide range of containment measures, such as masking, cohorting, cancellation of high-risk activities, distancing, hygiene protocols, reduced class sizes and enhanced ventilation.
Both children and adults in schools have been primary cases – meaning that children or adults may be the first to spread the infection to others in any given environment. A good way to measure and compare how infection is transmitted from primary cases is to calculate the “secondary attack rate” (the number of new cases in an initial case infected, per 100 exposed individuals) and separately for children and adults. Reporting this rate. Secondary attack rates can also be compared between settings.
Infected children are often not diagnosed because they are less likely to be tested. Studies that randomly tested school children for an active infection did not detect widespread silent transmission between children and adults in those schools.
Seroprevalence studies, including a Canadian study from Vancouver that has not been peer-reviewed, have looked for the presence of antibodies after infection, and have shown that children with individualized learning are generally more likely to learn from other groups in the local community. infected at similar rates.
School outbreaks have been investigated and reported by researchers and in the media. It can be difficult to identify the origin of an outbreak and its transmission when multiple cases are diagnosed at the same time, and without a full outbreak investigation. Overall, children who came in contact with an infected member of the household had the highest risk of infection. The SARS-CoV-2 outbreak may be related to superspreading events, although, to our knowledge, no superspreading event has been attributed to a young child.
Read more: Some superspreaders transmit most coronavirus cases
Population studies estimate that the delta variant is two to three times more contagious than the wild breed and 50 percent more contagious than the alpha variant.
2. How are schools preventing the spread of diversity in schools and reducing airborne transmission?
It is important to implement infection control measures and guidelines to reduce the risk of infection in the school environment.
To reduce SARS-CoV-2 transmission, timely detection of epidemiological symptoms and testing, limiting direct contact or distance, number and mixing of contacts, ventilation, masking, standard hygiene practices and vaccination rely on a layered approach. This layered approach is also called the Swiss cheese model of infection prevention, where each additional measure prevents further transmission if the virus evades other barriers.
One study, which has not been peer-reviewed, estimated that this layered approach is necessary to control transmission in kindergarten to grade 12 schools with delta, as is other research about transmission in university environments. does.
However, measures should be tailored to local epidemiological and vaccination coverage, and tested for their feasibility (eg, feasibility of distance with young children).
Disinfection and cleaning require less attention, as transmission through surfaces or objects is unlikely. The extent to which distancing rules reduce transmission risk depends on additional measurements already in place (such as masking and ventilation) and the occupancy of the location.
The focus is on air quality and ventilation in the classroom. Some schools replace the quality of air filters used in mechanical systems or distribute portable HEPA filters. Others pledged to install carbon dioxide monitors.
3. Should schools test students for COVID-19?
Masks and masks are mandatory in many Canadian provinces guidelines for schools. Some parent groups and advocates in Alberta have criticized the decisions to drop the mask mandate in schools.
As there were insufficient data on the use and effectiveness of masks in young children, masks were applied inconsistently in Europe and the UK when the pandemic hit hardest in 2020-21.
The impact of masks is difficult to measure, especially in schools. We know that mask-wearing among adults reduces COVID-19 cases, and lowers mortality rates. Masks are a powerful tool against transmission, but wearing a mask alone is not enough.
Read more: Children, masks and back-to-school FAQs: Are cloth masks the best protection against COVID-19? How often should the mask be washed?
Masks also protect children from other respiratory infections, which have been spreading again since the spring. Additional barriers could reduce the spread of many other viruses, and reduce the amount of time students spend outside school because there are symptoms that cannot be distinguished from COVID-19 and lead to testing and quarantine. could.
The test has been used in schools to diagnose cases, in outbreak investigation, for quarantine guidance, and as a form of prevention. For example, tests could be implemented to reduce the duration of quarantine. The test can also be used to prevent students and teachers from coming to school if they are contagious.
Repetitive, weekly and bi-weekly testing has been used as an added layer of protection. However, the burden and cost associated with testing are enormous, especially when community incidences are low and only a small number of cases can be taken up. A more realistic option would be to randomly select a few schools to monitor viral circulation across the country.
Whether the test is used for preventive screening or for diagnosis, it is important that samples are collected in a child-friendly manner, for example, using gargle samples, sputum or saliva. Tests should be equitably accessible and readily available to the family, and results should be available rapidly to reduce time spent in uncertainty.
There must also be some false positives in the type of tests provided for children, so that we do not isolate children who are no longer carrying the infectious virus.
Another concern is children who are tested and receive a false negative result (the test says negative, but they are actually positive). Both test errors have a disruptive effect and cause damage. There is a need for easy, accessible and frequent testing with a moderately sensitive but highly specific test.
Vaccination is the most effective direct and permanent prevention against infectious diseases. Vaccine mandates and other initiatives that are all eligible – encouraging vaccines to increase vaccine coverage in teachers and schools of older children – appear to be the most valuable strategies for reducing transmission.
4. Which infection prevention and control best practices should schools follow?
The set of mitigation practices described in question number 3 have been implemented in most countries. However, there are major differences in the intensity, method, coordination, communication and measurement of their implementation and their feasibility.
In terms of mass vaccination, Canada is one of the lucky countries to implement it widely. Some countries around the world have not been as lucky.
Many countries developed guidelines for infection prevention and control measurements, often set by the ministries of public health and education.
The advice of pediatric medical societies and their experts has been integrated into some of the guidelines. The European Centers for Disease Prevention and Control provides an overview of mitigation guidelines, as do the Centers for Disease Control and Prevention in the United States and the World Health Organization.
The Canadian government provided a guideline document, while the provinces are providing local guidelines.
Even in the neighboring European countries of Belgium, the Netherlands and Luxembourg, the measures differ. For example, masks are mandatory in Luxembourg’s primary school unless students are seated more than 1.5 meters apart in classrooms, which is possible because there are a maximum of 15–18 students per class. Masks are mandatory at all times inside primary schools in France, but not in Belgium or the Netherlands. Quarantine rules are also different in those countries.
Of course, experts’ recommendations don’t always align with political decisions.
This fall, policy-makers and school leaders alike must continue to implement preventive measures in schools. Parents, older children and all members of the community who are eligible for vaccination have a role to play in the vaccination. When children enter a challenging school year they may also hear children’s voices and experiences – and try to understand and practice their roles in keeping each other healthy.