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.