There is a distinct divide between two sets of health experts on what to do with Ontario schools.
Many pediatricians are calling for in-class learning to resume as soon as possible since kids' — and parents' — mental health is taking an undeniable hit at home with e-learning.
But some epidemiologists say it's too early to get kids back inside schools since the third wave is just abating and the B1617 variant from India could set off a fourth if measures are relaxed too quickly.
In the middle is the Ford government, which is refusing to commit to a course of action until a "consensus" is reached between all stakeholders.
That includes unions, which Premier Doug Ford said are looking at injunctions if schools are opened (unions deny this, but have <a href="https://www.qpbriefing.com/2021/05/13/ontario-stay-at-home-order-extended-until-june-2/" target="_blank" rel="noopener">left the door open</a> to using the tactic if they deem it necessary).
The June 30 end of the school year is fast approaching, and a consensus between all sides before then looks increasingly unlikely — though one medical officer has told 580 CFRA he expects a provincial announcement on reopening <a href="https://www.iheartradio.ca/580-cfra/audio-podcasts/ottawa-at-work-dr-paul-roumeliotis-is-the-worst-behind-us-or-should-we-be-concerned-with-the-india-variant-1.15272333?mode=Article" target="_blank" rel="noopener">this week</a>.
The Canadian Paediatric Society (CPS) says there is a consensus among its members.
"The impact of school closures and the resulting social isolation on the health and well-being of children and youth has become impossible to ignore. Getting Ontario's students back into the classroom, with appropriate safety measures in place, for the remainder of this school year and for summer learning must be a priority now," reads a <a href="https://twitter.com/CanPaedSociety/status/1395476426602782725/photo/1" target="_blank" rel="noopener">letter</a> sent to the government last week from the CPS and 11 other pediatric and children's aid groups.
But prominent Ontario epidemiologist Dr. David Fisman noted that intensive care numbers are still high and will decline slowly.
Even a small new wave of B1617 could cause a "catastrophic collapse of our health-care system because there's no room right now," he said, adding that the new strain is starting to "outcompete" the B117 variant that caused the third wave.
“We have every reason to believe we would have another wave if we put kids together in schools for a month with B1617 emerging," he said. "And we can avoid this by simply focusing on vaccination and focusing on making schools safe for September."
The CPS letter says reopening schools would have "minimal, if any, impact on the health-care system."
Fisman said that's simply not true.
"If that’s going to spark an epidemic that’s going to kill kids' parents, you’re not doing those kids a favour," he said.
Some have raised concerns that the debate is becoming nasty.
"Every trusted group of pediatricians, scientists, medical officers, etc., is pushing hard to open schools and has been for weeks," Niagara Region's associate medical officer of health, Dr. Andrea Feller, recently tweeted.
In response, Dr. Diego Bassani, an epidemiologist and senior scientist in child health evaluative sciences with SickKids — which signed the letter calling for school reopening — tweeted, "We reached the ‘you’re either with them, or you’re not trusted’ stage of the pandemic."
Some experts say the groups should have focused their energy on calling for safer standards in schools just as strongly as they're now calling for classes to reopen.
<blockquote class="twitter-tweet" data-width="500" data-dnt="true">
Right? Does CPS want to comment on the fact that public schools in Ontario are crowded, underfunded, and some literally have *no* ventilation? Those are pandemic issues, but also child health and learning issues that precede, and will outlast, the pandemic
&mdash; David Fisman (@DFisman) <a href="https://twitter.com/DFisman/status/1395716796645322755?ref_src=twsrc%5Etfw">May 21, 2021</a></blockquote>
<script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
"As it stands this is just, 'Once more unto the breach,'" tweeted Dr. Yoni Freedhoff, an Ottawa family medicine physician.
Beyond a consensus, what Ford said he was "mostly concerned about" last week was new modelling from experts advising the government, which projected an increase in COVID-19 cases of six to 11 per cent if schools were reopened on June 2.
"We can't afford an increase of 11 per cent right now," Ford said.
The modelling said that increase "may be manageable," but would likely come at the cost of reopening other sectors to control community spread.
Data from the United Kingdom <a href="https://www.publichealthontario.ca/-/media/documents/ncov/phm/2021/05/covid-19-school-reopening-evidence-approaches.pdf?la=en" target="_blank" rel="noopener">show</a> that COVID surges can be kept low as schools reopen, with stricter measures outside schools in place for five to six weeks afterward.
Ontario currently plans to start reopening around mid-June, in less than three weeks.
One London expert noted that a lack of data and testing may be under-reporting spread in England.
<blockquote class="twitter-tweet" data-width="500" data-dnt="true">
SHORT THREAD ON SCHOOLS: As we open up, schools are becoming the biggest places where large groups of unvaccinated people mix. This makes them more vulnerable to outbreaks if local cases increase. But data on what is happening in schools is sparse.
&mdash; Prof. Christina Pagel (@chrischirp) <a href="https://twitter.com/chrischirp/status/1396972891544109064?ref_src=twsrc%5Etfw">May 24, 2021</a></blockquote>
<script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
"As we open up, schools are becoming the biggest places where large groups of unvaccinated people mix. This makes them more vulnerable to outbreaks if local cases increase. But data on what is happening in schools is sparse," tweeted Christina Pagel, the director of the Clinical Operational Research Unit at University College London.
She also noted that Singapore closed its schools this month, citing data that show the B1617 variant may affect children more than previous strains.
"The Singaporeans are telling us this amplifies like crazy in schools," Fisman said. "The U.K. is saying the same thing, where you're really seeing it surge, particularly in parts of the U.K. with real strong ties to South Asia ... you're seeing it surge in teenagers and in their parents, kind of the 30 to 39s and the teenagers, with a sense there that it really is amplifying in schools."
Chief Medical Officer of Health Dr. David Williams said he wants schools to reopen, saying the increase in cases would be controllable.
“My position is that I've been encouraging schools to open as soon as possible,” he said
Williams added that every medical officer of health in the province agrees with him — the Council of Ontario Medical Officers of Health have written a letter saying as much — but some have conditions.
Dr. Lawrence Loh, Peel's top doctor, said that his hard-hit region is looking better, but isn't at 100 per cent yet.
"We are in constant dialogue with [the province] and recognize the benefits of in-person learning especially for children’s mental health," he said in a statement. "We continue to monitor the numbers in Peel and are optimistic that they are trending in a favourable direction that, if maintained, might support a return to in-person learning."
Niagara's medical officer of health, Dr. Mustafa Hirji, said he supports reopening if his region's cases fall below 40 per 100,000 per week, and the reproductive number falls below 0.9. He said he believes both metrics will be hit by May 31.
The premier also said he'd like to get all kids 12 and up their first vaccine doses by the end of June, which "plays a factor in [school reopening] as well."
Education Minister Stephen Lecce's office didn't address questions sent by email, saying, “We will continue to rely on expert medical advice to keep children and staff safe as we continue our work to reduce transmission in the community.”
The Liberal and Green leaders said schools should reopen as soon as possible, but only if they are made safer, while the NDP education critic said the decision should be left to Ontario's COVID-19 Science Advisory Table.
NDP education critic Marit Stiles said investments in air quality assessments and smaller class sizes are needed, and the government needs to start keeping track of how many education workers are vaccinated.
"I have to say, just opening up a window is not going to be the answer," she told QP Briefing by phone.
A recent <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e1.htm" target="_blank" rel="noopener">study</a> from the U.S. Centers for Disease Control shows increased ventilation is key to slowing spread in schools.
Green Leader Mike Schreiner called for Ford to release a "concrete plan" to make schools safe for reopening.
"He’s refused to lower class sizes, has delayed addressing ventilation issues, and failed to use rapid testing abundantly and effectively," he said in a statement. "Instead of blaming a lack of consensus for the absence of a plan, Ford needs to show leadership and provide clarity on what is happening with schools."
Liberal Leader Steven Del Duca also said he'd like to see in-person learning resume "as soon as possible," but that it will require more funding for smaller class sizes and better ventilation.
He also called for the government to allow local public health units to decide if schools in their regions should reopen this year; and for Ford to "immediately reach out, and work with the education community" on how to reopen for September.

Pediatricians and epidemiologists divided on school reopening as Ford government seeks consensus

Read this for free.