COVID-19 is a hard problem. It is larger than building a Canadarm, larger than a hydroelectric dam at Niagara Falls, and larger than the tallest freestanding structure for 32 years. COVID-19 is a problem that requires engagement by everyone, every step of the way. Lives have been lost. Now is the time to hope for the best, but plan for the worst.

Let’s be conservative.

On June 19th, 2020, the Ontario government published a set of guidelines for re-opening schools in September, which was based on stringent measures of increased sanitation, hygiene, and social distancing. On July 30th, 2020, a new and far less strict plan was published. The current plan for Ontario’s schools to return to full class size is based on the premise that children are not significant contributors to spreading COVID-19. Current scientific data don’t support this claim.

The impact of a COVID-19 resurgence and an ensuing lockdown would be substantially worse than initiating preventative measures. Preventative measures are an investment in enabling Ontario to operate safely (see “Impact of COVID-19 on Ontario’s Economy” below).

When children return to school in September, we need to minimize the spread of COVID-19 and to maximize the well-being of families and their ability to support themselves. Investing in education now by reducing class sizes to prevent a resurgence of COVID-19 would avoid a catastrophic impact on our health care and economy due to returning to a state of lockdown. As of July 30th, Ontario’s reported case rate for COVID-19 has remained steady at under 200 per day; we are not yet even near zero. 

Current understanding of COVID-19 epidemiology

The most significant measure for reducing the spread of COVID-19 is to minimize contact between people to reduce the spread of infection. While Remdesivir is progress for treatment, its partial reduction of recovery time and mortality is further inhibited by availability. In the light of limited treatment, the uncertainty of immunity to COVID-19, and the unavailability of a vaccine, the best approach to contain the disease is to minimize its spread.

Recent studies highlight the following aspects of COVID-19 transmission necessary to consider when re-opening schools:

• Asymptomatic adult carriers of COVID-19 have the same virus load as symptomatic carriers, suggesting asymptomatic carriers can be efficient transmitters.
• There are other debilitating outcomes from COVID-19 other than death ranging from a prolonged recovery period to multiple organ failure that have a profound impact on income, employment, long term disability, parenting, and support from the government.
• Children are less likely to suffer from COVID-19 than adults and show milder symptoms, potentially allowing infections to spread unnoticed.
• Young symptomatic children (less than five years old) have at least as high or even 10-100 times higher viral load in their upper respiratory tracts as symptomatic adults. These data alert that symptomatic children may be more effective carriers and transmitters.
• In children, SARS-CoV-2 persists in faecal samples even after clearing from the respiratory tract, which has the potential to transmit the virus (especially in kindergarten) even after negative tests.
• Antibodies against SARS-CoV-2 can fade quickly in both symptomatic and asymptomatic cases, in which case re-infection remains an open question.

It is premature at best to claim that schools aren’t a significant transmission route for COVID-19. Until we have substantial evidence to support these claims, we cannot risk people’s livelihoods and lives on a hope.

Successes in other Countries

To determine if the plan currently proposed by the Ontario government would be effective, we sought countries with a flat or decreasing curve of infections for COVID-19. We then examined their school policies: whether schools were opened and, if so, what constraints were in effect. If we found countries that matched these criteria using the same plan as Ontario, we could have confidence in that plan.

We did not include countries such as Switzerland, Netherlands, Denmark, Germany, and Norway, which are often cited as examples of a successful school re-opening as they currently have an increase in positive cases. It’s impossible to isolate the contribution of schools reopening from lifting lockdown restrictions in other aspects of society. Therefore, we focus on countries that re-opened schools without a subsequent spike in positive cases.

South Korea, Finland, China, and New Zealand have demonstrated a collection of core measures that may be contributing to their continued success at reducing the spread of COVID-19. Ontario includes a number of these measures in their plan:

• Monitoring for symptoms  among students, parents, and staff,
• Scheduled recess/lunch breaks for each class,
• Scheduled drop-off/pick-up and ban of visitors to the school,
• Frequent sanitation of surfaces,
• Enhanced hand hygiene,
• Online learning for vulnerable students, staff, or family members.

However, two essential measures stand out as different from the proposed Ontario plan: 

• Social distancing at school: either 2 meters between desks or 1 meter with a personal shield,
• Learning cohorts that isolate from other cohorts.

These additional measures may not have been the deciding factor for the flat or reducing curves of these countries; however, they do distinguish these countries from others. We should avail ourselves of these tactics to restrict the cohort to the size of the class based on two-meter distancing (or one meter with a personal shield). It’s important to bear in mind, however, that a cohort of students isn’t truly restricted to just the students in the class. There are siblings in other classes or friends in a social bubble who go to different classes or schools. Each connection outside that cohort is an opportunity to spread COVID-19 amongst those least likely to exhibit symptoms. The network of opportunities to spread COVID-19 grows far faster than the size of the cohort.

Let’s learn from the mistakes elsewhere and not take unnecessary risks. Victoria, Australia, Hong Kong, or even the US are indicators of what will happen if we are not careful with how we roll back restrictions in Ontario.

Proposal

The originally published set of guidelines for Ontario were far more stringent in what was allowed and would have been far more effective than what has since been published. In particular, the relaxation for limits for the size of classes in elementary school and the imprecision in terminology for class sizes in secondary school seem problematic. Furthermore, numerous recommendations for labeling, coordination, ventilation and other details are excluded in the ‘updated’ guidelines. Allowing students to interact with up to 100 other students and teachers via the education system is adopting substantial risk.

Reopening schools in September should focus on three goals:

• Health
• Education
• Fostering financial well-being

The following proposal develops from the original set of guidelines but adjusts several key components.

• The only students that study remotely are those with health risks or those that choose to.
• Elementary students who intend to return to in-class learning belong to cohorts as described; however, the number of students is constrained based on either 2-meter distancing or 1-meter distancing with plastic barriers between students:
  • Such distancing requires fewer students than a cap of 15 in the cohort based on what the room supports.
  • There is no alternation of online and offline, either daily or weekly. There is one cohort throughout the school year.
  • Students and instructors are spaced around the edge of the classroom such that no student needs to come closer than two meters to enter or exit the classroom.
  • The cohorts that students belong to correspond as closely as possible to the extended family bubbles already established to maintain continuity and minimize cross infections.
  • The additional spacing increases the amount of time students spend in the classroom without requiring masks to facilitate communication and education.
• Minimize unsupervised interactions between students by opening earlier and later for drop off and pick up to support direct admission to the classroom and avoid congregating outside the school.
• Extend the school day and stagger day start and end for cohorts:
  • Provide cohort specific coverage for care within the class instead of separate care.
  • Parents directly drop off and pick up their students if feasible.
  • Staggered starts and stops allow for staggered bussing where possible to reduce bus load size (ideally clustered by cohort but may not be feasible with multiple students in a family).
  • More time is dedicated to coordinating activities within the school for recess, lunch, breaks, and study time.
  • Use the opportunity for additional cleaning and clearing of air (particularly in fall and winter).
• The school has a pool of extra staff devoted just to the school to fulfill a supporting role for instructors:
  • They are familiar with the curriculum and can continue if the primary instructor is unavailable.
  • Substantially reduces the probability of bringing in a substitute to cover the class, thereby minimizing the risk of spreading illness if the primary teacher is unavailable.
  • Support to the primary instructor, allowing them to take breaks.
  • Work with students who are ill at home and remote (this is not intended to increase the class size beyond what it supports).
  • Coordinate specialists via technology.
  • Coordinate for resources related to maintaining health and safety of the class (such as getting additional masks, coordinating the distribution of supplies, etc.).
  • Monitor and enforce student conformance to health guidelines.
• Masks are provided by the school and replaced regularly throughout the day based on recommendations of no more than two hours wearing a mask:
  • Given the spacing scenarios above, masks are required for situations where closer interaction occurs (such as group work).
  • Masks are collected after use and at the end of the day.
  • Masks are washed nightly to ensure they are clean and safe to use the next day.
  • These strategies ensure all students have access to masks and follow safety criteria.
• Students and staff with cell phones are obligated to have the Ontario contact tracing application installed and Bluetooth enabled.

These are in addition to the original proposal of staggered recess, frequent sanitizing of classrooms and shared spaces, contact tracing, physical and mental health support, adaptations to curriculum, coordination of common areas, etc.

The particular concern with mask-wearing is accessibility for all students, the associated cost, and the uniform care and cleaning of masks. By establishing a more rigorous procedure for masks, we can more effectively reduce the spread of COVID-19 amongst the pre- and asymptomatic carriers.

The change in spacing requirements for classrooms is likely to require more facilities beyond what schools can contain themselves. To address this space shortage, we can use underutilized facilities starting with those that already receive government funding such as community centres, science centres, museums, art galleries, stadiums, and exhibition centres to name a few. The list can be expanded to spaces in hotels, conference centres, office buildings, gyms, fitness studios, and vacant properties. If necessary properties can be purchased to provide facilities, they can be resold in the future when we have a vaccine (and property values have increased). Further investment may be required in places that don’t have such buildings readily available.

This extraordinary investment benefits more than education: jobs and infrastructure shifts the cost away from health care and can recoup some of that investment. Such investments are substantially better than paying the same or more for people to stay at home during a lockdown.

We don’t yet know if a vaccine can be produced for COVID-19 and, if so, what its efficacy will be. We need resilience to this possibility and any other future infectious disease. Our elected officials can demonstrate their commitment to our education system both in quality and care by having our children attend public school.

Impact of COVID-19 on Ontario’s Economy

On March 25th, Ontario’s government announced a $17 billion package to address the impact of COVID-19. The impact of COVID-19 on Ontario’s economy includes the loss of personal income tax (23% of Ontario’s income) due to unemployment, the loss of sales tax (18.1%) due to reduced expenditures, and the loss of corporate taxes (10.8%) due to lost revenue and failed businesses. Out of an estimated $150 billion income for Ontario, these represent just over 50% of that income. In January 2020, Ontario’s unemployment fell from 5.3% in December to 5.2% only to rise to 13.6% in May, representing over one million people in Ontario. This in spite of the Ontario Government’s $3.7 billion designated to directly support people and protect jobs and another $10 billion in tax and other deferrals to protect jobs and budgets (part of the $17 billion COVID-19 response package in March). Estimates place the impact of COVID-19 at over $20 billion on Ontario’s income. This estimate is based on a gradual economic recovery beginning in the summer. This is in addition to the increased expenditure by the government to address the COVID-19 outbreak made in March.

We have already lost over $17 billion in tourism alone. How have our other industries fared? If there is another lockdown, will Ontario be able to afford another $13-14 billion to protect jobs and industry in addition to a resurgence in unemployment and lost tax revenue that could impact the bottom line by another $20 billion or more? Another lockdown where parents will not be able to go to work with children at home?

How does this compare to the proposal here? As listed in the 2018-2019 annual report, education accounts for 19.3% of expenditures for Ontario ($28.7 Billion). An increased investment of $15-20 billion to reduce class sizes and additional safety measures would also have a return on investment with taxes on salary, sales tax, and fostering industry and employment in Ontario.

Conclusion

Overall, the current plan for school-reopening doesn’t offer sufficient levels of protection for Ontarians against the spread of COVID-19. The measures we suggest in this proposal will be costly but effective against a resurgence of the pandemic. The costs associated with a resurgence, which is likely if the current plan stays in place, will surpass the costs of investment in reopening schools safely.

Let’s be cautious, let’s invest in lives and ensure Ontario is A Place to Grow.

Corresponding Google Document