SickKids report recommends children return to school in September

The Hospital for Sick Children says children should be allowed to go back to school in September even though the virus will likely still be around in the fall.

The recommendations are contained in a report released Wednesday which says the risks of infection and transmission in children, which appear to be minimal, need to be balanced with the effects closed schools are having on their physical and mental health.

The report acknowledges the fear and anxiety parents, children and school staff have about a return to class this fall by attempting to address a number of concerns such as screening, hand hygiene, physical distancing, use of non-medical masks, and more.

“We have to accept that COVID-19 will stay with us for a long time. We must move on with certain activities in our lives, such as schooling, while keeping in mind that there are a lot of ways to mitigate risk,” says Dr. Ronald Cohn, President and CEO of SickKids and one of the authors of the report.

“Not opening schools in September would continue to have a negative impact on the mental, behavioural and developmental health of children. We hope these recommendations help provide a framework to keep everyone safe when school doors reopen.”

The scientists who worked on the report point out that children account for less than 5-10 per cent of COVID-19 cases globally and in Canada, kids up to 19 years of age make up just 7 per cent of all cases reported as of June 15.

“We know from the flu and from many other respiratory viruses that a child often acts as the super-spreader, and that is something that we really have not seen (with COVID),” Cohn said in a webinar Wednesday.

“None of the studies are suggesting that children do not transmit it at all. It’s just not at the high frequency that any of us would have expected.”

Dr. Jeremy Friedman, associate pediatrician-in-chief at SickKids, said 5,000 symptomatic children were tested with the COVID nasal swab at the hospital since March and only 30 were found positive. The hospital also tested 1,500 asymptomatic children with a nasal swab and found zero positive cases.

COVID-19 causes a “less severe presentation in children,” said Friedman, with only seven cases requiring hospitalization at SickKids, and none needing ICU admission.

The report says while self-isolation and stay at home measures have helped to “flatten the curve” they have also had unintended consequences on children’s behaviour and mental health, such as depression, exposure to domestic violence, child abuse and neglect and even suicide.

While the report’s authors anticipate an increase in COVID-19 cases once schools are reopened, they are suggesting proactive measures to mitigate the effects of such an increase.

• It’s recommended that parents and caregivers screen students for symptoms of coronavirus before they head off to school rather than having the schools conduct on site temperature testing which will likely result in increased lineups and delayed entry.
• A regular schedule for routine hand hygiene, above and beyond what is usually recommended is also advised and children should also be taught how to clean their hands properly “in a non-judgemental and positive manner.”
• Non-medical and medical face masks are not required or recommended for children returning to school, adding it is not practical for a child to wear a mask properly for the duration of a school day. For teachers, wearing a mask is a reasonable option if close prolonged contact with others cannot be avoided and teachers should explain the rationale to students.
• Strict physical distancing should not be emphasized to children in the school setting as it is not practical and could cause significant psychological harm. During outdoor activities, such as recess, physical distancing should not be required.
• Sports and physical education classes should be encouraged and schools should endeavor to offer as many of their usual clubs and activities as possible.
• When it comes to the mixing of students and staff, the report says while it would like to see less mixing between classes and years, student well-being and mental health should be prioritized and class or program switching should not be denied on the basis of cohorting.
• A regular cleaning schedule should be used with emphasis on high touch surfaces along with reinforcing “no sharing” policies when it comes to food, water bottles or cutlery.

Mitigating risk for students who are immunocompromised or have pre-existing conditions that could make them more susceptible to a severe COVID outcome should also be taken into consideration, the experts say. Friedman said that could mean offering a virtual learning option for those students.

“We would strongly encourage the schools to try and create a situation where that opportunity (for a safe learning environment) is available for all children right across the board,” he added.

And if parents or guardians of kids are immunocompromised, Friedman says additional precautions may need to be taken to allow the child to still go to school.

SickKids says it has worked closely with Ontario’s Ministry of Education to provide guidance on how to safely reopen schools in the fall.

Cohn says the Ministry of Education has “reacted towards (the) document in a very positive way.”

Ontario Education Minister Stephen Lecce says the safety of students, staff and their families will continue to be the priority in deciding when to reopen classrooms.

“We will take a cautious approach that underscores our complete commitment to safety,” Lecce said in a statement. “We also appreciate the advice from the Hospital For Sick Children related to the importance of robust mental health supports, to ensure this transition is positive. We will ensure those supports are in place.”

The complete SickKids report on children returning to school can be viewed below:

Files from The Canadian Press were used in this report