SickKids guidance for return to school only a starting point, critics say

A document from a Toronto hospital that provides guidance for reopening Ontario schools in September garnered criticism from some epidemiologists, while other experts say it offers a useful starting point in the conversation.

Dr. Zoe Hyde of the University of Western Australia in Perth posted a thread on Twitter Thursday outlining "serious concerns" about the document that was released by SickKids a day earlier.

Dr. Nisha Thampi, a pediatric infectious disease specialist with the Children's Hospital of Eastern Ontario in Ottawa, was among the Canadian experts to also post her thoughts on the social media platform.

Thampi called the SickKids document a "launching pad" and said "broad consultation" should be the next step toward figuring out a safe return plan. She reiterated that in a phone interview.

"I can appreciate that with the profile that SickKids has, that there may have been a higher expectation for more definitive guidance," Thampi said from Ottawa. "But really, for me the focus of this guidance was that children need to go back to school in September because it's the right thing to do."

"[The document]actually serves as a launching pad for more conversations with broader stakeholders," she added. "I think what's remarkable is that Twitter has afforded us an opportunity to see how engaged Ontarians are in this discussion in coming to a solution that makes families feel safe, teachers feel safe, and most importantly of all, normalizes the experience for children who have already been bearing the brunt of so much of this pandemic shutdown."

Among the key issues epidemiologistsare debating are whether children are less likely to be infected by the novel coronavirus and suffer compications from COVID-19, and if there is enough evidence to suggest they're less likely to act as vectors of the disease than previously believed.

The SickKids document said "evidence is mounting" that children are less susceptible to COVID-19 and could be less likely to spread it.

Hyde took issue with that statement on Twitter and questioned the references cited in the document, including "a peculiar review" by a Swedish epidemiologist Jonas Ludvigsson that she said incorrectly reported no COVID outbreaks in Swedish schools.

Questions on transmission in children

Thampi said Ontario has "limited knowledge" of COVID-19 transmission in children because of early school closures and lockdowns. She added that Ontario kids were not being tested for COVID for months "unless they were admitted" to a hospital.

Dr. Ronald Cohn, the President and CEO of SickKids, acknowledged the criticism in a phone interview Thursday.

In response to the claim the Swedish study is misleading, Cohn said that while the study is not entirely clear in its scientific validity, there are much more recent data that suggest children may not be spreading COVID-19 to the degree one would have initially thought.

"This is really synthesized data from different parts of the world. We're not making this up," he said. "We have to still take it with a grain of salt but there is a lot of evidence that has been brought forward.

"I'm not saying it's not in the document nor anywhere else we are not saying that they are not transmitting the disease. It just appears to be at a lower frequency than one would expect."

The SickKids team said Wednesday that 5,000 symptomatic children were tested with a COVID nasal swab at their hospital since March, with only 30 testing positive. They also tested 1,500 asymptomatic children and found zero positive results.

Hyde also criticized a statement in the SickKids document that said there is a "lack of evidence" to show that wearing a face mask can halt the spread of the virus among children. She said no one has studied this, "as far as I know."

While face masks have become more commonplace among the general public in recent weeks, the recommendations from the SickKids team does not require children use them in classrooms.

Face shields for teachers?

Dr. Michelle Science of SickKids said Wednesday that incorrect use of masks can lead to an increased risk of infection and they wouldn't recommend them, especially for younger children. If students wanted to wear face masks, Science said "we certainly wouldn't discourage that," however.

Thampi suggested a closer look into face shields instead of masks at least for teachers.

"What I like about face shields are that they're reusable, they're cleanable, it covers more of your face. ... and also, especially for a child, it's helpful in terms of being able to read people's facial expressions," she said.

"It's important for them to be able to have that nonverbal communication and also for the teacher to have his or her eyes protected as well."

Ontario's Education Minister Stephen Lecce responded to the criticism Thursday, saying that the province is consulting "widely" with medical experts and scientific leaders across the country including those at SickKids in order to compile its own guidelines for a safe reopening of schools.

Lecceadded that he has confidence in SickKids as a "leading institute when it comes to the safety of children and health promotion for our youth."

Hyde and Thampi both believe children should be returning to school, but proper safety should be considered before that can happen.

Cohn said the SickKids document was meant to provide a framework for that.

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"We won't be able to eliminate the risk but we can mitigate the risk," he said. "We can balance the mitigation of risk against children being isolated at home and not being with their friends at school.

"I think we have to find a balance ... under the assumption that our public health criteria would allow children to go to school and with this advice we think it can be done safely."

Thampi said that what might be "missing" from the SickKids document is a detailed outline of how safety precautions would play out. But she said those decisions can't be made by epidemiologists or clinicians alone.

"If the expectation was for a comprehensive document, then yes, it's missing something about bus services or education resources for families. But we're looking at a document brought together by clinical experts in infectious diseases," she said.

"So I think it's very helpful for them to have set out a framework for infection prevention and control by clinical experts in child development and complex care."