SickKids-led group of experts proposes latest guidance for school reopening

TORONTO - A group of experts from across Ontario have come together to develop updated considerations for a safe school reopening amid the COVID-19 pandemic. The living document, Updated COVID-19: Guidance for School Reopening (pdf), published July 29, 2020, builds on the initial set of recommendations put forward by The Hospital for Sick Children (SickKids) and Unity Health Toronto, with input from experts from a wide range of disciplines across the province. 

The authors agree bringing children and youth back to school for in-person, full-time learning, with appropriate risk-mitigation strategies to ensure everyone’s safety, is the ultimate goal. Together, they examined the latest evidence from around the world and reviewed the experiences from other jurisdictions to inform how students and staff in Ontario can safely return to school in September. However, as research into COVID-19 continues to rapidly evolve, the authors caution the document may need to be updated accordingly. The authors drafted and accepted the guidance statements based on consensus and highlighted areas of disagreement as additional viewpoints. 

The new document represents a refinement of the previous recommendations with additional considerations for a spectrum of stakeholders as they prepare to return to school. It highlights the need to consider the epidemiology of COVID-19 in decision making and provides recommended health and safety measures, with age and developmental considerations, to support schools in keeping students, staff and their families safe. The authors stress that keeping schools open safely will be facilitated by low rates of community transmission and everyone has a significant role in adhering to public health recommendations to keep community transmission as low as possible. It also emphasizes the importance of monitoring the impact of school reopening on the transmission in the community.    

The document was a collaborative effort between SickKids, CHEO, Holland Bloorview Kids Rehabilitation Hospital, Kingston Health Sciences Centre, Children’s Hospital at London Health Sciences Centre, McMaster Children’s Hospital and Unity Health. Paediatric and adult infectious diseases specialists, epidemiologists, paediatricians, psychiatrists, public health officials, teachers and parents provided input. 

Drs. Ronald Cohn, President and CEO of SickKids, and Michelle Science, Staff Physician in the Division of Infectious Diseases at SickKids, were joined by other contributors to the document at a virtual news conference on July 29, 2020, to discuss the latest guidance statements and answer questions from the media. 

COVID-19: Guidance for School Reopening Report

This living document is meant to provide information to policy-makers by highlighting paediatric-specific considerations based on our collective experience with children and their families/caregivers. In this updated version, refinements have been made with contributions and endorsements from other Ontario paediatric hospitals, epidemiologists, public health physicians, and a volunteer advisory group of teachers and parents.

Download COVID-19 Recommendations for School Reopening Report (pdf)

Quick facts

• Updated COVID-19: Guidance for School Reopening builds on the previous document. Some of the changes include: 
  • Increased focus on epidemiology of COVID-19 and the influence of community transmission on school reopening plans. 
  • Additional discussion on the benefits and risks of mandatory masking in schools with age-specific and epidemiological considerations. 
  • Additional guidance statements on implementing physical distancing in schools with age-specific considerations.
  • Enhanced guidance statements for children and youth with medical, physical, developmental and/or behavioural complexities. 
  • Additional guidance statements on safety for teachers and school staff. 
  • Suggested priority areas of research to close crucial knowledge gaps. 
• Multiple reports from around the world indicate that children and youth account for less than 5-10% of SARS-CoV-2 symptomatic infections. In Canada, of 111,911 COVID-19 cases reported as of July 26, 2020, 8,890 (7.5 per cent) were in individuals aged 0 to 19 years. 
• Current evidence suggests that young children may be less susceptible to COVID-19 and children younger than 10 years of age are probably less likely to transmit the disease than older children and adults. There is also strong evidence that the majority of children who get COVID-19 may not display any symptoms or have only mild symptoms.
• School closures have significant adverse health and welfare consequences for children and youth. Some of these unintended consequences include adverse impacts on children’s behaviour and mental health, food insecurity and increased risk of family violence. The goal of reopening schools should be to maximize child and youth health rather than facilitate a return to work for parents and caregivers.

Quotes

"As leaders in children’s health, our most important opportunity at this moment is the careful planning of a safe, successful return to daily school. With this document, we have endeavoured to provide helpful considerations for educators, school boards and administrators, parents, and students, as they chart the course for returning to the classroom. I am hopeful that with the appropriate safety measures in place, this year’s Back-to-School period, while unique, will be a healthy, safe and fulfilling one for all." 
- Dr. Ronald Cohn, President and CEO, SickKids, and co-author of the document 

"This document brings together current evidence that can be used in local communities throughout the province to get kids back into schools. It provides a foundation to guide important conversations that should now occur between policy-makers, local school boards, educators, public health units and, if called upon, other health experts."  
- Dr. Lindy Samson, Chief of Staff and Infectious Diseases Physician, CHEO, and co-author of the document 

"The gap in learning support during the pandemic has significantly impacted children with special needs. We know that families with special needs are reporting worsening mood, anxiety, inattention, and irritability since the onset of school closures and other emergency measures. As government and school boards plan re-opening scenarios, children with special needs must be considered." 
- Dr. Evdokia Anagnostou, Senior Clinician Scientist, Paediatric Neurologist and Co-Lead of the Autism Research Centre at Holland Bloorview Kids Rehabilitation Hospital, and co-author of the document 

"We are pleased to have collaborated on these evidence-based guidelines, which aim to help education officials and other key stakeholders make decisions that will allow children to safely return to school this fall. It is our hope that these recommendations will serve as an important baseline that can be tailored to the specific needs of each region based on their unique populations, evolving local epidemiology and public health advice." 
- Dr. Michelle Barton-Forbes, Division Chief, Paediatric Infectious Diseases, Children’s Hospital at London Health Sciences Centre, and co-author of the document 

"Children and youth need to be physically, mentally and emotionally supported as they return to school this September. We’re pleased to partner with fellow hospitals to provide evidence-based recommendations to help ensure a safe and positive back-to-school season for kids across Ontario." 
- Dr. Jeffrey Pernica, Medical Director, Infectious Disease Service, McMaster Children's Hospital, and co-author of the document 

"I am excited about these new guidelines because not only do they describe ways to minimize risk of infection as children return to school, but they also consider equity in access to education and the important role school plays in the overall wellbeing of children and youth." 
- Dr. Sloane Freeman, Lead Pediatrician for the Model Schools Pediatric Initiative at St. Michael’s Hospital, Unity Health Toronto, and co-author of the document