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Back-to-school: Coronavirus 'Ask Me Anything' with Dr. Vinita Dubey (Aug 31)

Last Updated Sep 5, 2020 at 10:35 pm EDT

We know you have questions about the ongoing coronavirus pandemic and we’re working to get you the answers, straight from the most trusted sources.

Toronto’s Associate Medical Officer of Health, Dr. Vinita Dubey, answered your back-to-school questions in connection with COVID-19 in a LIVE video interview on Monday, August 31, at 12:30 p.m. on our Facebook page as well as here on our website.

Full transcript of the Q&A session:

(Questions and answers were moderated and have been edited for grammar, punctuation and clarity)

Q: Should I send my kids to school? What are the factors I should consider before making a decision?

A: There’s a number of factors to consider.

First look at your child or your children. How well can they follow instructions? What age are they? How well do they learn? Can they keep a mask on? Can they follow instructions and do they.

Then you want to look at your home environment. Are there vulnerables in your house or in your social circle that you need to consider? And what about the logistics of  – could you handle online learning for your child or is that not a possibility? Do you need to send your children to school because of work?

Another component to think about is what are you going do when your child is sick? I think that’s another piece that has to be played in. If they have symptoms, it’s going to be different now and so you have to be prepared for that piece as well.


Q: As we see regularly, most cases are in Peel, Toronto and Ottawa. Why is there no regional approach for increasing measures in these spots in terms of schools reopening?

A: Exactly, we have seen higher cases in the Greater Toronto area.

So in high schools in the Greater Toronto area they are going to be doing what’s called an adaptive model. So they will have half a day in class and half a day online and right that adaptive model has only been applied for high schools and up, it has not been applied for elementary students.

I think as things progress we can definitely expect to see some regional variations in what school boards do related to COVID and providing school in certain parts of Ontario.


Q: If a child at school wears a mask and someone in the cohort is diagnosed with COVID-19, then why does the child need to stay home for 14 days? Is it the same situation in doctors in hospitals – if you’re exposed to somebody, you have to stay home for 14 days?

A: In a hospital environment we’re wearing hospital grade personal protective equipment and so we have a medical mask on, some sort of eye protection, whether it’s a visor or a face shield or goggles. If we’re actually seeing a patient who may have coronavirus, additional precautions are taken. And so if that patient has COVID we have full protection — the ability for them to actually infect us is very low. We would still be notified and have to watch for symptoms, but could still continue to attend work. Again, when we attend work, we are wearing our personal protective equipment, so should we come down with COVID the likelihood of us spreading it to others is very low.

In a classroom environment, even though children will be wearing masks, we’re giving them mask free breaks. They can take their mask off when they have lunch, when they’re outdoors and we recognize that there may be times when they can’t maintain physical distance. Also, they’re wearing a cloth mask which is not medical grade mask.

Those are some of the reasons why the approach is different. In Toronto Public Health — what we do when there’s a case anywhere, including in a classroom, we do what’s  called a risk assessment. And so we actually evaluate — was everyone in that class considered a cohort and could have had close contact with the person who was sick? Maybe the sick individual who got COVID was not even actually in school when they were contagious. In that case for the cohort, nothing would have to happen to them.

So we do that risk assessment and then based on that give recommendations or requirements to people who may have been exposed to the person on whether they have to self-isolate for two weeks or whether they could continue to attend school but might have to just monitor for symptoms.


Q: How high do the case counts have to get before we shut down schools again?

A: We are keeping a close eye on the case counts. They are starting to creep up.

I actually just had a meeting today with the Toronto District School board on this matter to start talking about at what point would we maybe use an adaptive model or go to online learning because the case counts are too high.

And so our staff at Toronto Public Health are keeping a close eye on those numbers and reviewing the literature to figure out what might be some thresholds to determine that. It won’t likely be a specific number. Will it be the number for all of the city? Would it be for a particular neighborhoods or particular schools? If they have a couple of cases that they can’t link back, it might just be a school issue, it might not be a neighborhood issue.

So all of these things we’re keeping a close eye on so that we can provide that guidance on when schools need to shift models or even consider closing.

The guidance is also based on our surveillance. Surveillance means we’re keeping a close eye on the numbers. Who’s getting the cases? Where are the cases? What are the characteristics of the cases? All of which will be able to inform public health measures and deciding on a public health measure like closing a school is definitely in the purview of what Toronto Public Health would be doing.


Q: Are kids being asked to get tested before going back to school?

A: In Ontario, that is not a requirement. I know that is a requirement or recommendation in other places, but not in Ontario.

When we get tested — the test result is only as good on that day. If you test negative, it doesn’t necessarily mean that you’re incubating. If you have symptoms you should stay home and get tested. But we’re not requiring all staff or students to be tested before they start school.


Q: Students are being asked to wear masks all day. Will they be breathing in more carbon dioxide and will it cause any future problems with their lungs?

A: It’s important to mention that healthcare professionals can and often do wear masks all day as well. There has been no associated links with higher carbon dioxide and with adverse health effects.

I think the important thing to note is that students will be wearing cloth masks or disposable masks that are equivalent to cloth masks and they actually are breathable. When you pick a cloth mask you need to pick a material that is breathable. Breathable means that when you Exhale, the CO2 will be able to leave the mask and it’s not just sitting inside there.

The other important thing to note is that we’ve asked schools to build in mask breaks throughout the day. So you will take your mask off to have your lunch, you will take your mask off when you’re outdoors, for example, and so it won’t be a continuous five hours straight of wearing a mask.


Q: Can you please explain why limits for indoor gatherings don’t apply to schools but they do for other indoor gatherings?

A: A lot of our guidance is related to public situations and schools are separate.

The indoor gathering limit is still 50 though and this is why we have told schools not to hold assemblies because an assembly would be 50 plus students.

There should not be any classrooms that have 50 students or more. We have recommended that indoor gatherings within schools should be postponed. If they were to proceed they would have to follow the same rules of no more than 50 as well.

That stipulation is per room. The whole school itself can be more than 50, just like in a workplace. You could have a building that would have more than 50 people who would attend the workplace.


Q: Why is it OK to have one metre physical distancing in schools but it’s two metres everywhere else? And what is the actual safe distance?

A: So the answer is it could be both. The more distance the better.

The reason why we picked two meters is if I were to cough here and you’re two meters or more away from me, the likelihood of my droplets spreading to you is less.

We know though that one metre is better than no metres and the World Health Organization actually recommends one meter.

Other places, like the UK, are recommending 1.4 meters. So you are seeing variance in terms of what people are recommending for distance. What we do say in our Toronto public health materials is where two meters is not possible, and it’s not always going to be possible, maintaining as much distance as possible will be helpful.


Q: When a child is deemed sick at school and cannot be picked up right away, what happens to that child — who is looking after that child or are their special measures for children who start showing symptoms at school?

A: That’s part of the protocol that school boards have had to develop. It includes a wellness room or an isolation room where — if there’s a  sick child, or even a sick staff member who can’t go home right away — they are to go into that room.

There are precautions in place, personal protective measures, cleaning precautions so that the child could wait, with observation, until they can be picked up. And then there are measures in place to make sure that the room is clean and that staff is wearing appropriate personal protective equipment.


Q: Could you please explain opting in and opting out of in-person classes and how that will work?

A: This is a question for your particular school or school board on how it’s to work.
What we know is that the Ministry of Education has asked school boards to develop three plans — one plan is regular learning and for Toronto that means elementary schools will be in regular classes, full-time classes.

Then there’s the adaptive learning, which in Toronto means high schools will have half day classes and half day online remote learning.

The third one is online only, where for some of the boards in Toronto have to set up a whole online school that your child will be a part of. So those are the three models that each school board has to develop and has developed.

There will be certain dates of entry to choose in-person or online learning so check with your board.


Q: What are the attendance guidelines for kids with coughs, runny noses, nausea, etc. If there is a situation where a child may be coughing one morning this week or have a runny nose the next week, would they need to be tested twice and would they need to stay home for 14 days each time they have one of those symptoms?

A: We’re trying to firm up our guidance here.

There’s no question that each child and each staff is going to have to complete a screening questionnaire every morning which will ask if you have a new or worsening cough, runny nose, trouble breathing? All of those symptoms. If you do, you will have to stay home.

The recommendation is that you go and get tested if you have symptoms. If you test negative, then 24 hours after your symptoms get better, you can actually return to school. So suppose you had a cough one week, you tested negative and then a week later now you have a new symptom. Well, it’s hard to say what’s causing that new symptom, so we’re hoping to get further guidance on that.

Certainly getting tested — if the test is negative, your symptoms go away then you go back to school. That’s a very clear path that will likely remain.

In terms of getting tested again — if it’s a new cough or it’s a worsening cough you might need another test. Just because they had a cough and they were tested doesn’t mean now that they have another symptom that it will still be negative.

If they had a cough the first week and it was negative, the cough hasn’t changed or gotten worse, maybe it’s because they have asthma — then that’s a different story. So there will be some assessment that will be required.


Q: I have three children and between them, my wife and I there’s lots of runny noses and coughs throughout a typical school year. If one of the kids has to stay home, do all the kids stay home until we get a negative result or for 14 days? Or is it just for 24 hours till the symptoms are gone?

A: So again, this is part of what we’re hoping to get a firmer guidance.

If you have someone at home who has a symptom, we are not requiring right now that the whole household needs to stay home. The person with symptoms should go and get tested because if they come back positive in that situation, then the whole household would need to stay home for 14 days – that’s currently what our guidance is

Some of these finer details we are still firming up so that we can be consistent and provide that guidance in the school setting.


Q: Why are high school kids only going back 50 per cent of the time?

A: High schools are using the adaptive model where it’s half day in school, half day online learning.

So that, as I understand, they will be getting a full day of learning but only half of it will be in school. The reason for that is recognizing that the cases in Toronto and the GTA are still present, the risks are higher.

In high school classrooms, it can be difficult to physical distance. So if you have half of the students in the morning, the other half in the afternoon, you can have smaller classes.

High school students are also don’t require babysitting, for example. We also know that high school students are closer to adults when it comes to COVID. They may get COVID or spread it more similar to adults than say, younger children, who we think may be more likely to have milder symptoms and may not spread it as much. So that’s another reason why having smaller class sizes in the high schools has been adopted.


Q: What are the recommendations for students on school buses? Do they have to wear masks and how many kids per seat?

A: So you’ll have to check with your particular school’s transportation company about what their recommendations are.

In general, wearing a mask on a school bus is a good idea. Make sure you do the screening at home before you come to the school as much as can be done. We are recommending that students try to sit in the same spot so that if someone on the school bus gets COVID, you know who has been around them compared to the whole bus.

So these are the types of measures that you can expect, but what specifically is being recommended for your school bus, I would ask your transportation company.


Q: If a student has to stay home for 14 days do they automatically switch to online learning then or do they miss 14 days of school?

A: That’s a question for your school board but from what I understand, if you choose exclusive online learning that is your only mode.

If you are sick though, I would imagine it would be the teacher who you currently have who would make arrangements for you as would be the case when you’re sick otherwise. But the particular details on that you should follow up with your school and your teacher on those details.


Q: Will people be able to call Toronto Public Health if they feel that their child’s classroom is not safe?

A: You’re always welcome to call us if you live in Toronto, our number is 338-7600.

If you have specific questions about a classroom or about your school, please go to the school first, because I think that’s the first measure for you to go to try and get your concerns addressed. But you are always welcome to call us, absolutely.


Q: How will we have kids social distance as at recess when they’re allowed to take their masks off?

A: Outdoor play is important and it’s also less risky for COVID — so not wearing your mask while you’re playing outdoors is something that we are saying is allowed.

We are so recommending that students, as much as they can, maintain a physical distance. Recognizing even when they’re outdoors and they’re brushing by each other, they’re running past each other, that if they can’t maintain that physical distance, that risk is lower.


Q: Kids might be a part of different cohorts in school and after school programs. What are the safety measures taken for those kids who will be in more than one cohort?

A: So we the safety measures are actually outlined — the Ministry of Education has a before and after school care guidance documents that before and after school care programs will have to follow.

They will be very similar to what’s being held in schools. I think what you should recognize as well, if you have a child that may be a part of two cohorts of the measures that will be in place will have to be followed so that the risks can be reduced.


Q: How healthy is it for kids to be masked up all day when they don’t have proper ventilation in class?

A: We’re not recommending that kids be masked all day. We are definitely recommending that kids have mask-free breaks throughout the day, recognizing that masks can be difficult to wear for the whole day.

I think also sending one or two clean masks in clean bags for your child will also help, so that if the mask gets hot, sweaty or there’s saliva inside of it, that the child can be at liberty to put that in a dirty mask bag and change their mask. Maybe you tell them they have a mask for the morning and another for the afternoon that they change after lunch, plus they have one spare one so that they could tolerate the mask and learn to bear it.


Q: Elementary kids are eating lunch at their desks in their classrooms. Given that they will be indoors and won’t be spaced two metres apart, isn’t that going to be risky without mask?

A: Some of the recommendations for eating lunch are making sure to distance as much as possible. So it might mean spreading out the classroom, maybe not eating at your desk, but spreading out chairs so that you can keep as much distance as possible.

Not talking during lunch is another recommendation. The actual act of eating doesn’t necessarily transmit COVID, but if you’re eating at your desk and you’re not talking as much as can be maintained that, will be helpful as well.

We’ve recommended to school boards to have lunch outside as much as possible, maybe during lunch, the windows are opened as well — so those are some of the measures that can be put in place to actually reduce the risk.

Q: You mentioned that classes might be held outside when possible, but what happens in the winter?

A: In the winter time, obviously learning math outside is not something that’s going to be possible, but being outdoors as much as possible is still something that’s recommended, so I think that we have to try and adapt.

Even in the winter, if some of our learning, maybe a science unit or something could be done outdoors, we can try and do that as well.


Q: Is it true that teachers unions can shut down the school year under their agreement for their health and safety?

A: I not familiar with the union and the answer to that.

I think what is important is that staff, whether its teachers or other staff working in schools, will be given personal protective equipment to make their work environment safe. That’s actually a requirement for any staff, no matter what kind of work you do, you should be provided the proper protection so that you can do your job and be protected.


Q: Can you explain the difference between having social distancing rules in restaurants and stores but not in schools?

A: Our main message is the same regardless. Keep your physical distance, wear a mask, wash your hands often and stay home when you’re sick. That has been our message to the school boards as well.

We recognize that in some classrooms, in some schools at some times you will not be able to maintain that distance. So when you can’t, that’s why wearing a mask is important, because it will give you that protection when you can’t maintain that physical distance.

Plus making sure that we don’t have people in the classroom who are sick, who are coughing who can then spread droplets. So those are all layered approaches to help reduce the risk, especially when you can’t keep that physical distance.

Q: Who is monitoring how well schools are cleaned and how often they are cleaned?

A: Toronto Public Health has provided guidance. We’ve relied on some of the guidance that’s available from Public Health Ontario and Public Health Agency of Canada to provide guidance to schools on cleaning and they have protocols in place for cleaning.

For each school, you would have to ask your principal who is the one who’s going to monitor the cleaning to make sure it’s done. But there are certainly policies, procedures and guidelines in place on cleaning.


Q: In some grades, there may be shared instructions between different classes. The students would remain in their own class while the teachers switch back and forth throughout the day. Are the kids at a greater risk of COVID exposure if there are shared instructions?

A: We provided guidance to the school boards about when a teacher has to go between classrooms and how that can be done safely.

The risk is the teacher spreading their germs to the students and also the teacher picking up germs from other classrooms. So it is important to make sure that the teacher who goes between classrooms has a mask on, maybe if there’s plexiglass available, make sure they keep that two meter distance at all times really — because if they can keep that two meter distance despite teaching in front of the class in different classrooms, the risk to themselves and the rest of the class will be actually very low.


Q: Do students who has asthma get to have mask breaks?

A: We’re recommending that all students have mask breaks, because we recognize that wearing a mask for the whole day is going to be difficult.

Those who have a medical condition where they couldn’t wear a mask – that might be an exception. If a child needs a mask break when there isn’t a classroom mask break, you could talk about having procedures in place where they might go to a place where they have a two metre distance,take the mask off, take that mask break and then put it back on for example.


Q: Is it really safe for our kids to go back to school? Shouldn’t we at least wait till December or later?

A: I think every parent has to make that decision.

Some parents who feel that it’s not safe to send their kids back can certainly choose the online option — every school board is required to have that option for exactly that reason.

I think we will continue to follow to decide at some point maybe schools need to be shut down. That is something that Toronto Public Health will be following to be able to make that assessment.

I think you can expect that we will see cases of COVID in schools. One case in a school doesn’t mean that all schools need to be shut down. Even two cases in a school might not even mean that that school needs to be shut down.

We certainly do not want to see COVID spread and putting things on hold, shutting things down is one of our public health measures. I want parents to know that that’s a decision for Public Health. School boards can also be conservative and make that decision, but often we do it together. But it is not something that will be left to the school boards, it is a Public Health action.

Watch the full interview with web writer Dilshad Burman in conversation with Dr. Vinita Dubey in the video above.

Scroll through the questions submitted to this session below.

Note: questions were moderated before appearing in the chat window