Public health officials are warning of the critical role that schools could play in slowing the spread of novel coronavirus, also known as COVID-19.
On February 28, 2020, the Public Health Agency of Canada released new guidelines for schools and child-care facilities to manage the risks of the virus. The agency stated that there is currently no widespread transmission of COVID-19 in Canada; therefore, it recommends that schools take standard respiratory precautions – the same precautions recommended every year for cold and influenza season. The agency also states that, at present, it does not recommend school closures.
Among other things, the guidelines state: "Virus transmission in the school/childcare setting, as well as in the home and community, is amplified as students/children are generally less compliant with effective hand hygiene and respiratory etiquette practices." The agency indicates that the way children socialize with their peers is likely to increase the risk of transmission.
The guidelines ask schools to boost the availability of hand sanitizers, do away with perfect attendance awards, monitor students for signs of illness and restrict children from sharing food.
Keeping parents/caregivers informed
The guidelines confirm that parents/caregivers will be a major source of comfort and reassurance to their children. "It will be important for the school to keep parents/caregivers informed of what the school is doing to protect their children, including how they are preventing the spread of respiratory infections and what parents can do at home (e.g. reinforce hand hygiene and respiratory etiquette, environmental cleaning and increased reassurance)." Parents/caregivers will be the ones who decide about keeping their children home if they are sick and, as such, open and frequent communication will be important in ensuring that sick children do not go to school.
Respiratory etiquette in school settings includes covering the mouth and nose while coughing or sneezing with a tissue or into the elbow and disposing of used tissues in a plastic-lined garbage can.
If the local public health authority advises students or staff to self-monitor for symptoms or self-isolate at home due to return from travel in an affected area or illness, the school community should make efforts to support families to ensure:
- Sick leave policies are in place and school attendance is flexible;
- Families are treated with respect, fairness and compassion, with a focus on dignity and protection of privacy;
- Steps are taken to reduce the potential for stigma and discrimination;
- If students are self-isolating at home, measures are in place to provide meaningful homework to students so they do not fall behind in their studies. Consider a relaxed approach to missed work due to self-isolation or illness; and
- If students are self-monitoring for symptoms, measures are in place to recognize symptoms while in school and to separate sick students and staff from others if symptoms develop.
Theresa Tam, Canada's chief public health officer, has warned Canadians to prepare for the possibility that schools may need to close. Japan has taken the step of closing its schools for about a month to help contain the spread of COVID-19.
On March 4, 2020, Toronto Public Health confirmed that there has been an increase in cases of COVID-19 in Iran, and a small number of individuals in the community with a recent travel history in this country have contracted the virus. As a result, there is now a new direction for people who have travelled to Iran. If a student or staff member has recently travelled to Iran, Toronto Public Health is asking them to self-isolate for a period of 14 days after their last day in Iran. This is similar to advice for returning travellers from Hubei Province, China.
Toronto Public Health has asked that if an individual has travelled to mainland China, Hong Kong, South Korea, Italy and Singapore, they should monitor for symptoms of COVID-19 for 14 days after leaving the affected area. If students or school staff are making travel plans in the near future, including over the March break, they should consult the Government of Canada website for current travel advice and advisories related to COVID-19. Some countries have entry and exit restrictions.
As of March 8, 2020, 62 cases of COVID-19 were confirmed in Canada, but public health officials have warned that they expect the numbers to rise.
Cancelling school trips
On March 3, 2020, the Toronto Catholic District School Board indicated that it had cancelled all upcoming March Break and Easter trips to Europe. The decision impacts educational trips operated by private tour companies that were planned in 12 Catholic high schools.
The announcement by the board came a day after the Canadian government upgraded the travel advisory for northern Italy. Canadian officials now warn against all non-essential travel there. They advise travellers to "take normal security precautions" in the rest of the country.
School boards and independent schools who are reviewing cancelling school trips should review the cancellation and refund provisions set out in their contracts with the tour operators. In addition, in the event that families have their own travel insurance, the question will arise as to the scope of coverage under the relevant policies. Each case will depend on its own individual facts in light of the language in the individual travel contracts.
There have been about 7,375 cases of COVID-19 in Italy reported as of March 9. Most are concentrated around the northern region, which includes popular tourist destinations such as Milan and Venice. In the rest of the continent, the situation is evolving. Officials warned that the epidemic in Europe will probably get much worse before it is contained, as the number of infections across the continent jumped sharply from fewer than 4,000 on March 4 to well over 11,500 on March 9.
As of March 9, the number of cases in Britain rose to 273, Germany reported 902 cases, Spain reported 589 cases and France had 1,126 reported cases of the virus.
Michael Gardam, chief of staff of Toronto's Humber River Hospital and an infection-control expert, said that Canadians should get used to the fact that this virus will likely be around for the foreseeable future. The next few months will likely bring inconvenience and disruption, but as time goes on, people will figure out how to adjust to the new normal, he said.
On March 5, British Columbia identified Canada's first known case of community transmission of COVID-19. Provincial Health Officer Bonnie Henry stated that the patient, a woman in her 50s, has not recently travelled and has no contact with anyone known to have COVID-19.
Community spread is significant, because it means the virus could be spreading untraced since there is no clear link to the source of the illness.
In response, British Columbia and some hospitals in Ontario have added COVID-19 testing to existing influenza surveillance networks, meaning that a broad range of people with flu-like symptoms are being tested regardless of travel history. Ontario has implemented an enhanced response structure, which includes a "Command Table" as a single point of oversight to provide executive leadership and strategic direction. However, public health officials still currently assess the risk to Canadians as low.
For Ontario schools, the spread of the virus has created confusion, parental concern and questions around the obligations of schools.
Follow the advice of local public health authorities
Schools should follow the advice of Toronto Public Health or other government health authorities in their decision-making. Schools should not be shutting down or quarantining students or staff, unless advised to do so by a government health authority.
Ontario's Chief Medical Officer of Health, David Williams, sent a letter to the school community on January 27, 2020. He stated:
"The health and well-being of Ontarians, including and especially our students and school staff, is Ontario's top priority. Students, parents and school communities should rest assured that the province is working together in close cooperation with its partners in both the education and health care sectors to ensure the continued safety and well-being of students and staff."
He reiterated that the risk to Ontario residents remains low.
As the situation currently stands, schools should focus on ensuring consistent and regular messaging to students, parents and staff, reassuring them that the school is monitoring the situation carefully and following the direction of public health authorities in Canada. The messages should also remind them that, as always, parents should not send their children to school if they feel unwell.
Schools should also take pre-emptive measures such as increasing the frequency of surface cleaning and ensuring that hand sanitizer units are prominent in additional locations throughout the school. Staff should remind students of the importance of washing their hands and the need to cough or sneeze into their elbows or tissues. This could also be an opportunity for school boards and independent schools to consider revising or implementing a pandemic response plan. This plan should clearly delegate and set out responsibilities of school leadership and staff.
The Ontario Human Rights Commission recently issued a statement reminding people that discriminatory action against any persons or communities because of an association with COVID-19, whether perceived or otherwise, is prohibited by the Ontario Human Rights Code. COVID-19 is not isolated to people of any particular ethnic origin, citizenship, place of origin or race. In this regard, schools should be careful of privacy obligations, especially surrounding personal health information.
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