Schools have mostly stayed open amid COVID-19, but experts warn of winter flu season ahead

Less than two weeks into school this fall, Kathy Maloney knew the virtual option was not working for her kids. Both were growing increasingly frustrated at being unable to fully participate in their digital classrooms.

"Their educational experience is totally suffering," she recalls thinking. 

She ultimately switched them back to attending their Milton, Ont., school in person, but the decision required a leap of faith. 

"It became a trust and belief system that everyone was going to do their part to make sure that they were safe, their kids were safe and that — if their kids had the sniffles or ... a little bit of a cough — they would keep their kids home," Maloney said.

While Maloney has been satisfied so far and appreciates the administrators' openness to addressing parental concerns, she's also prepared to revisit her decision — if there's a rise in cases tied to her children's school, for instance, or if classmates begin testing positive.

"That's call for pulling them out and just reassessing the situation all over again," she said.

A little over two months into the school year, the fear of a widespread shutdown like Canada experienced in the spring has not materialized. At the same time, schools have also not been immune to COVID-19. Though health and safety measures seem to have helped, health experts are raising additional concerns, especially as winter approaches.

According to the Public Health Agency of Canada's (PHAC) most recent weekly COVID-19 epidemiology report, schools and childcare centres accounted for the highest number of outbreaks in September, and the second-highest in October (after long-term care and retirement residences). British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Quebec have all had school outbreaks, while New Brunswick has also seen a few individual school-related cases.

PHAC considers it an outbreak in a school or childcare centre when there are two or more cases reported, and has noted that 64 per cent of schools with COVID-19 cases had only a single case reported. 

The agency's analysis excluded Quebec schools, citing unavailable data about the number of cases per school, but a Montreal behavioural medicine specialist believes there's cause for concern in her province.

School-aged children and teens account for a growing percentage of Quebec's rising COVID-19 case count — a worrying trend, said Kim Lavoie, professor and Canada Research Chair in behavioural medicine at the University of Quebec at Montreal.  

"It's really the school-aged kids, primarily the 10-to-19 age group, that are counting for the highest number of cases now in Quebec," said Lavoie, who said nearly 300 positive COVID-19 cases per 100,000 inhabitants in Quebec are from the 10-to-19 age group. 

Lavoie, who has a daughter in high school and a son in elementary, attributes the rise among Quebec school-aged children and teens in part to a lack of preventative measures used by schools in other provinces — such as mandatory mask-wearing across a wider age range of students — since the start of the school year.

"We've been playing catch-up ever since." 

She's concerned that poor ventilation in Quebec schools will compound the issue as colder weather descends. 

"With [Canada's Chief Public Health Officer Dr. Theresa] Tam releasing evidence now that the virus can be transmitted not only through droplets but through airborne transmission, the ventilation problem — now that winter is upon us — is a really big concern," Lavoie said.

"When you have classrooms of 30-plus kids and poor ventilation, the solution cannot be to simply open the windows during our long, cold winters." 

Manitoba, which in recent weeks joined Canada's COVID-19 hot zones, reported on Tuesday a five-day, rolling average test-positivity rate of 10.6 per cent — the highest it's ever been. But amid a range of closures, schools are staying open, said Dr. Brent Roussin, Manitoba's chief public health officer. 

"We are making these sacrifices and changes so schools and child care centres can stay safe and stay open," Roussin said Tuesday.

"We're not seeing widespread transmission of the virus in schools, despite many cases that are community acquired. We haven't seen that to translate into transmission in schools, not at least to high degrees."

WATCH | COVID-19: What's working in schools and what's not?

COVID-19: What’s working in schools and what’s not?

4 years ago

Duration 5:56

Two infectious disease specialists answer questions about COVID-19 and what’s been done to keep schools safe, whether the protocols are working or if the restrictions have gone too far.

'We can't let our guard down'

Overall, Canada's schools have been doing well, agreed Winnipeg epidemiologist Cynthia Carr, but that doesn't mean they can relax infection control and prevention measures. These have included physical distancing, student cohorts, time spent outdoors, improving ventilation, masking and increased hand hygiene. 

"We have been quite successful in terms of safety in school reopening, even given that some areas have been hotspots for community-based spread," said Carr, founder of EPI Research Inc. 

She noted that outbreaks in schools and daycare settings have generally had relatively low numbers of cases per outbreak (3.4 cases/outbreak) so far and zero deaths associated with them. However, she also emphasized that successful school re-openings worldwide have been linked to low community spread.

"The more cases are in the community, the more chance it is to get into the school," Carr said. "What I'm saying today about success could change dramatically in a week or two… We can't let our guard down with respect to school with this continual increase in community-based spread, because it could hit us in a week or two and it could hit hard."

In the coming months, Carr will be keeping an eye on Canada's influenza rates — if they stay low, as they did during winter in the Southern Hemisphere this year, it will mean less stress for Canada's hospitals and emergency rooms, she said. 

As well, since symptoms of the flu overlap with those for COVID-19, Carr noted that kids who experience influenza symptoms will likely need to be tested for COVID-19.

"So then what is our testing capacity to keep up with all of that?" she said.

Testing and tracing 'crucial'

That COVID-19 doesn't seem to have been spreading wildly in schools so far may be because school-aged children and school staffers have been a group prioritized in contact tracing, said Dr. Nisha Thampi, a pediatric infectious disease physician and medical director of the infection prevention and control program at the Children's Hospital of Eastern Ontario. 

She acknowledged that more young Canadians under the age of 19 are now testing positive for COVID-19 than before, but attributed the cases to community spread rather than in-school spread.

"We should expect that cases in schools continue to reflect what we're seeing in our communities," Thampi said. 

"That's not to say that schools are unsafe, but it speaks to the importance of our health and safety measures in schools, as well as remembering that every interaction that we have in our community — and every opportunity that we take to reduce our risk during these interactions — contribute to making school safe."

Thampi is calling for improvements in testing and tracing, which she calls "crucial" for schools going forward.

She said she wants to see non-invasive tests employed — for example, the ones British Columbia and Nova Scotia have approved, which she feels children are more likely to tolerate on multiple occasions — so that students can be "tested frequently and appropriately," as an expected rise in seasonal respiratory viral infections hits and another surge in testing is expected.

"Our testing system needs to be strengthened and I would prefer that it be over prepared rather than overwhelmed, as we saw back in September."

With a strong system to test, trace and isolate COVID-19 cases, "we have a better chance of reducing the spread of disease in [different] contexts, including schools,: she said. "The more that we can do to protect our community, the safer our schools will be and we'll be able to keep them open."