A group of medical experts that have been advising the Ford government on the safe operation of schools say that the suspension of in-person learning should be a “a last resort for pandemic control” given the “significant negative impact” that last year’s prolonged closure had on children.

The advice is contained in an updated guidance document released by The Hospital for Sick Children on Thursday.

In it, the experts say that the delay in reopening schools for in-person learning “must be as time-limited as possible” given that it will “inevitably further exacerbate the harms to children and the inequities” already caused by school closures.

“In considering decisions about ongoing regional closure of schools for in-person learning, it is important to balance the health risks of SARS-CoV-2 infection in children and their role as potential transmitters of SARS-CoV-2 with the significant harms of school closure on children’s physical health, developmental health, mental health and learning,” the document states. “Given the significant negative impact that the initial prolonged school closure (to in-person learning) had on children and youth, it is our strong opinion that an in-person school model with robust application of the recommended risk mitigation interventions is the best option from an overall health and learning perspective for children of all ages allowing for consistency, stability and equity.”

Experts don’t recommend widespread asymptomatic testing

The Ford government allowed schools in northern Ontario to reopen on Jan. 11 and has said that schools in another seven regions, mostly clustered in eastern Ontario, will be allowed to resume in-person instruction on Monday.

Schools, however, will remain closed in 20 of Ontario’s 34 public health units for the time being and the Ford government has said that students in the five hotspot regions – Toronto, York, Peel, Hamilton and Windsor-Essex – won’t return to classrooms until at least Feb. 10.

The new SickKids report says that in order to keep schools open even in regions in which community transmission is high there must be “robust testing and contact tracing” alongside infection prevention and control measures.

The report says that any child with symptoms known to be associated with COVID-19 should be tested “as soon as possible” and that those children exposed to a student or a staff member with a positive case should also be tested themselves, even if they are asymptomatic.

But the report stops short of recommending widespread surveillance testing, which the Ford government has promised to expand across the province as part of the eventual reopening of schools.

Instead, it says that surveillance testing should only be done in “moderate to high prevalence settings and in schools with outbreaks identified.”

It also notes that the “identification of cases though surveillance testing is expected and should not, by itself, be a reason to close schools.”

Speaking with reporters during a briefing on Thursday afternoon, Associate Medical Officer of Health Dr. Barbara Yaffe said that in-person learning is important “for a whole host of reasons,” including the mental and physical wellbeing of children. But she said that a spike in positivity rates among school-aged children over the holidays left the government in a difficult position.

“There was so much transmission that we felt at that point that it would be safer to keep them at home in the south part of the province,” she said.

Cohorting rather than physical distancing for younger children

The panel of SickKids experts last updated their guidance over the summer, prior to the reopening of schools in the fall.

Since then there have been more than 7,300 cases reported in Ontario schools, including more than 5,000 that involved students.

There have also been 54 schools that have had to temporarily close due to an outbreak or operational issues.

In the updated guidance released on Thursday, the experts say that some combination of cohorting and masking should now be “strongly considered” as a replacement for physical distancing in lower grades, which they say is “likely detrimental” to the well-being of children.

They said that cohort sizes should be based on local trends with the resources required for smaller classes being preserved for regions with higher levels of community transmission.

Meanwhile, the experts were split on whether to recommend the use of masks for all elementary school students but agreed that the policy does make sense in regions with higher levels of transmission.

The Ford government previously extended its mask mandate for schools to include all students in Grade 1-3, a group that was previously exempted.

“The Chief Medical Officer of Health has said schools have been safe places to learn and SickKids has confirmed that the return to school this past fall was successful at a time when community transmission was low,” Caitlin Clark, who is a spokesperson for Minister of Education Stephen Lecce, said in a written statement provided to CP24 on Thursday. “We continue to follow their guidance by increasing infection prevention measures while we face heightened community transmission, including by enhancing Canada’s strongest masking protocols to include grades 1-3, expanding access to targeted surveillance testing, stricter screening protocols, along with ventilation improvements – all measures suggested by SickKids and other children’s hospitals today.”

In addition to the recommendations around testing and masking, the SickKids experts also cited research suggesting that 70 per cent of children have reported a worsening of their mental health since the start of the pandemic and said a “proactive approach” should be taken.

They said that “social interactions should be encouraged wherever possible” and “extracurricular activities should also be offered when possible.”