Do this for safer school opening – top epidemiologist

    Dr. Zoe Hyde is an epidemiology researcher at Western Australian Centre for Health and Ageing at University of Western Australia. We tracked her down after she said on Twitter: “Schools can only reopen safely if community transmission is low, otherwise outbreaks will occur. Child-to-child and child-to-adult transmission of #SARSCoV2 occurs, and that cases in children are being missed (which will affect the findings of some studies published to date). She cited new evidence that “children and adults are equally likely to be infected with #SARSCoV2 given the right circumstances.” 

    We sent her questions relevant to BC’s school reopening plans. Here are her answers to our questions.

    Q – Do new studies shed a different light on how readily kids of all ages become infected and how efficiently they transmit?

    A – In the early stages of the pandemic, there was some speculation that children may not be as susceptible to infection as adults and were less likely to transmit the virus. This idea probably arose because the effects of the virus are usually milder in children, and cases are easily missed. However, there is now a growing body of evidence that children are as likely to be infected as adults given the right circumstances, and that children do transmit the virus. It’s possible that children might transmit the virus slightly less efficiently than adults do, but we must also bear in mind that children typically have many more contacts than adults. The large number of contacts children have at school likely offsets any advantage of reduced transmission.

    Q – Is it possible that children will be in the driver’s seat propelling the pandemic by taking Covid-19 home as they do the flu?

    A – I’m not sure we can say that children will become the main driver of the pandemic. However, I think it is highly likely that children can play a substantial role in community transmission. This role must not be overlooked.

    Q – For months people have been told space is your ally, distance, and now parents are scared about the thought that our government wants them all in at school on same day on Sept. 8.

    A- We now have good evidence that interventions such as physical distancing and the widespread wearing of face masks can reduce transmission of the virus. We must apply these interventions across all strata of society, including children. I strongly suggest that schools adopt the Schools for Health: Risk Reduction Guidelines for Reopening Schools developed by the Harvard T. H. Chan School of Public Health.

    Q – The plan is for each primary school child to have maximum 60 cohorts and secondary to have 120 cohorts. Is that too much? What will the cumulative effect be on family of two secondary school children?

    A – Class sizes should be such that physical distancing between students and teachers is still possible. This might require some creative thinking, such as re-purposing large spaces in the school as classrooms, or even holding classes outside if the weather permits it.

    Q – How can distancing be created when classrooms are near capacity?

    A- In addition to increasing space between people, improving ventilation is extremely important. Doors and windows should be kept open if possible. Plexiglass barriers could be used in the classroom around desks.

    Q – Will mandatory masking help and should it be mandatory?

    A- The use of face masks by teachers and students is likely an effective way to reduce the risk of the virus being transmitted in schools. If possible, all staff and students should wear masks. Face shields could also be considered as an additional protective measure.

    Q – In the event of an outbreak how will contact tracing work with such large cohort?

    A – Where possible, children should be grouped into cohorts and encouraged not to interact with others outside their cohort. School arrival and departure times, changes between classrooms, and lunchtimes should be staggered to help maintain distance between cohorts. Should an outbreak occur, contact tracing may be easier if these guidelines are followed.

    Q – Should teachers be tested regularly to detect asymptomatic infection?

    A – Risk reduction strategies, such as the use of face masks, physical distancing, and improving ventilation, will likely limit the size of an outbreak should one occur. However, such measures do not replace the need for other measures such as staying home when sick and testing. Testing of asymptomatic students and staff via non-invasive methods like saliva testing should also be considered.

    Q – What is the chance of severe outbreaks if community level transmission is high. What level of daily cases is considered high or too high for a province the size of British Columbia with population of 5.1 million – roughly the same as Melbourne.

    A – School outbreaks seem inevitable if community transmission is high. To avoid this, schools should only reopen for face-to-face teaching when community transmission has been suppressed. Ideally, this would mean no cases with an unknown origin in a school’s catchment area for the preceding two weeks. In reality, this will be difficult to attain in many regions until a vaccine is available. In this circumstance, a tolerably low level of community transmission could be that which contact tracing is able to handle rapidly, such that transmission chains can be rapidly broken. If the number of cases rise and contact tracing becomes overburdened, then the level is too high.

    Q – We see Melbourne in the grip of another peak. What went wrong after such a stellar record during first peak? 

    A – The current situation in Melbourne can largely be traced to breaches in the hotel quarantine system. This allowed the virus to spread into the community unnoticed. The problem has been further compounded by a worryingly high proportion of people who have tested positive for the virus disobeying instructions to isolate at home.