ocpho backgrounder...page 1 of 16 june 30, 2020 ocpho backgrounder: coronavirus disease (covid-19),...

of 16

June 30, 2020

OCPHO Backgrounder: Coronavirus Disease (COVID-19), Children and the Re-Opening of Schools

In response to the COVID-19 pandemic and the limited available research on the virus at the time, schools were closed around the world, including the Northwest Territories (NWT). As new evidence emerges about the relationship between COVID-19 and children, it is recommended that school closures be reconsidered and for appropriate infection prevention and control (IPAC) measures and public health controls to be adopted to enable children and youth in the NWT to return to school safely. In doing so, there will need to be a balance between protecting against the spread of COVID-19 while ensuring the reduction of unintended harms. Evidence

Children and youth are low risk Evidence shows that children and youth (≤ 19 years of age) are at significantly lower risk of contracting1,2 and spreading3,4 COVID-19 in comparison to older age demographics. In regards to the risk of children contracting COVID-19 or experiencing severe health outcomes, in Canada as of June 15, 2020:

Children and youth ≤ 19 years of age overall represented as of June 1: o 7% of the total COVID-19 cases in Canada (n=98 945) o 1% of all hospitalization o 1 % of all Intensive Care Unit (ICU) admissions. o 0% of those deceased from COVID-19

Where a case could clearly identify the source of their exposure, schools & day cares combined only represented 1% of possible exposure settings of COVID-19 cases reported in Canada (May 2020).

The age distribution among confirmed cases in individuals less than 20 years of age (< 20 years old), in Canada as of April 27, 2020, can be found in Table 1. The rate of infection increases with age (with the exception of infants <1 year). Youth 15- to 19- years of age had the highest rate of infection per 100,000 cases among those < 20 years old (20.7), whereas children between 1- to 14- years-of-age show a lower, more consistent rate (7.1 -11.4)5. In Iceland, schools did not close and the proportion of children ≤ 10 years of age with COVID-19 remained limited, representing only 3.1% of all cases6. Evidence shows that children who

1 Li, et al. (2020). Age-dependant risks of incidence and mortality of COVID-19 in Hubei province and other parts of China. Medrxiv.

2 Hua et al. (2020). What we should know about SARS-CoV-2 infection in children. SSRN-Lancet Prepublication 3 Zhu et al. (2020). Children are unlikely to be the primary source of household SARS-CoV-2 infections. Medrxiv. 4 Danis et al. (2020). Cluster of coronavirus disease 2019 (Covid-19) in the French Alps. Clinical Infectious Diseases.

5 Paquette, D., Bell, C., Roy, M., Whitemore, L., Currie, A., Archibald, C., MacDonald, D., & Pennock, J. (2020). Laboratory-confirmed COVID-19 in children and youth in Canada, Janurary 15-April 27, 2020. 6 Gudbjartsson, D. F., Helhagen, A., Jonsson, H., Magnusson, O. T., Melsted, P., Norddahl, G. L., et al. (2020). Spread of SARS-CoV-2 in the Iceland population. New England Journal of Medicine.

of 16

do become infected with COVID-19 are most likely to get it from someone within their family.7,8,9 In terms of transmission, the risk of an infected child transmitting the infection is believed to be low. Those ≤ 19 years of age were less likely to be the index case and the one spreading COVID-19 to their families3. Additionally, a study out of France found that a child with COVID-19 who had attended three schools while symptomatic did not transmit the virus to any of their 172 contacts4. Though evidence continues to evolve, currently children are not at high risk of adverse health outcomes nor are they the primary contributor to the COIVD-19 pandemic. According to the June 17, COVID-19 Recommendations for School Reopening by SickKids10i, “Evidence is mounting that children may be less susceptible to SARS-CoV-2 infection and may be less likely to transmit the virus to others. There is also strong evidence that the majority of children who become infected with SARS-CoV-2 are either asymptomatic or have only mild symptoms, such as cough, fever, and sore throat. While serious disease requiring hospitalization is known in children, including multisystem inflammatory syndrome in children (MIS-C), this is relatively rare and is generally treatable. Severe disease requiring intensive care admission occurs in a small minority of paediatric cases, particularly among those with certain underlying medical conditions, but the clinical course is much less severe than in adults and deaths are uncommon. There have been no paediatric deaths reported in Canada to date”

More harm than good Therefore given the low risk of children contracting and transmitting COVID-19, the unintentional harms of closing schools must be seriously considered. To date, school closures have yielded adverse outcomes for children in the NWT. Since the last day of school on March 13, 2020, there has be a significant reduction in the reporting of child maltreatment to Social Services, however, this decrease in reporting is not indicative of less harm. Over the past seven weeks, there have been increases in child apprehensions, and serious incidences of child abuse.

Table 1: Age distribution among COVID 19 cases in Canada less than 20 years of age (N=938)

Age group (years) Frequency

Rate per 100,000 n %

younger than 1 42 4.5 11.4

1–4 109 11.6 7.1

5–9 152 16.2 7.5

10–14 215 22.9 11.2

15–19 420 44.8 20.7

Total 938 100 11.9

7 Xia et al. (2020). Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatric Pulmonary. 8 Wang, Y., Zhu, F., Wu, J., Wang, C., Liu, J., Chen, X., et al. (2020). Epidemiology and clinical characteristics of 74 children infected with Sars-CoV-2 in family clusters

in Wuhan, China. SSRN- Lancet Prepublication. 9 Wu, Q., Xing, Y., Shi, L., Li, W., Gao, Y., Pan, S., et al. (2020). Epidemiological and clinical characteristics of children with coronavirus disease 2019. Merxiv. 10

Science Michelle and Bitnun, Ari (June 17, 2020). COVID-19 Recommendations for School Reopening. SickKids

of 16

Recommended Action The public health principles of benevolence (do good) and non-maleficence (do no harm) must be considered in every public health control implemented during the COVID-19 pandemic. Given the evidence that those ≤ 19 years of age are not at high risk of contracting or transmitting COVID-19 in conjunction with the evidence of increased harm experienced by children NWT children as a result of school closures, the NWT Chief Public Health Officer (CPHO) recommends re-opening schools in the Northwest Territories. Below please find general federal guidance on re-opening and operating schools, as well as NWT specific requirements advised by the CPHO which need to be met in order to safely re-open schools. If schools are unable to meet this guidance, the OCPHO recommends partially opening schools to provide a safe space and food programming to at risk children and youth, following a risk assessment completed by OCPHO, with alternative guidance.

Federal Guidance for Daycare and Educational Settings to Open/Operate The following includes the general guidelines provided by Public Health Agency of Canada (PHAC) of ongoing public health controls required to safely re-open schools:

Maintain the provision of online learning as an option for students with conditions that place them at higher risk of severe illness from COVID-19 and those that have to isolate from travel (i.e. those with preexisting health conditions or immune-compromised, medical travel).

Core personal measures are maintained (i.e., provide hygiene education, supervised hand hygiene)

Screening of all staff and students/campers (communicate with parents/staff the importance to keep children/staff home if displaying signs and symptoms of illness)

Maintaining physical distance for junior kindergarten to grade 6 has been relaxed to limiting physical contact It is recommended that classrooms aim to act as bubble within the cohort (avoid mixing of students with other classrooms)

Maintain physical distancing as much as possible (i.e., separation of desks, no assemblies, no high-contact sports, no music involving high wind instruments or live singing, no indoor drama )

Staff and students at higher risk of severe illness can attend school as if there is no community spread of COVID-19 and they are stable.

Environmental cleaning (increase frequency of cleaning/disinfecting high-touch surfaces to a minimum of twice a day)

Non-medical masks may be considered but not mandatory (Not recommended for children <2 years of age)

of 16

NWT CPHO Recommended approach to re-opening schools in the NWT – Phase 2

Public health measures and hierarchy of controls

Protecting students, staff and others involved in an educational setting is of the utmost importance. General protective public health controls need to be in place to ensure that the safety of everyone is considered and acted upon. The hierarchy of control illustrates the types of controls based on their effectiveness to reduce transmission of infection and prioritization.

Physical Distancing: 2-metres apart or removing and limiting contact with at risk individuals. Engineering controls: ensure the physical environment is organized to prevent contact or spread of the virus. Administrative controls: ensure that people change the way they behave or work. Personal Protective Equipment (PPE): is used when all other controls are ineffective and distancing cannot be maintained.

of 16

Phase 2

Mitigated Risk Level

Mitigation Measures

Elementary Schools- JK-Grade 6

(Based on how schools in communities split their learning, the entire school could be accommodated or split classes could separate eg. 5/6 or 6/7 split)

Medium Physical Distancing:

Through spacing and time. Accommodate for full day re-entry. Staggered pick up and drop off. Allow parents to

walk students to curb to entrust transferring of students from parents to staff members if students need additional support.

Bubble concept- avoid mixing of classes with

staggered entry. Consider assigned seating.

Minimize congregate or communal settings. Consider webinars or digital announcements to

student body. Maintain online learning options or some form

of learning and continuous contact between the school and student if not available for those who are unable to attend due to their condition or isolation requirements.

Consider special options for persons at high-risk of severe illness such as curb side pick-up for assignments, special hours for tutoring, tele-commute/remote learning, etc.)

Thin out classroom to accommodate greater distance in desk spacing.

Physical distancing not required for outdoor play or sports for students 12 and under.

Physical distancing may be difficult in indoor setting with this population. Limit actual physical contact indoors.

Engineering Controls:

Physical barriers/Plexiglas. Entrance in one door and exit out another. Defined areas to pick-up and drop off Improve ventilation (assess HVAC or open

windows in warmer months). Encourage classes and "on the land learning"

outdoors weather permitting (open pavilion set-up)

Use visual markers to comply with physical spacing including the restructuring of class

of 16

design to allow teachers and support staff to maintain 6 feet of space from students

Consider enough time for students to exit the classroom and reenter without interacting with previous and/or next set of students.

Administrative Controls:

Minimize parents on-site. Switch elder programing or guest presentations

to online opportunities to limit the amount of people in the school especially those at high risk.

Telecommute if possible for nonessential staff. If staff must come in, identify ways that will limit their contact with others (i.e. staggered shifts, working in the evening while school is closed, work half days

Ensure that no staff and students that have symptoms of COVID-19 (fever, new or worsening cough, shortness of breath, muscle aches, extreme tiredness, sore throat, runny nose, headache, diarrhea, vomiting, loss of sense of smell or generally feeling unwell) come to school. They must remain home until they are well and follow health care provider advice. Cough (57%), runny nose (41.2%) and head ache (39.4%) were the most common symptoms among confirmed cases in those <20 years in Canada

o Ensure that all staff and students that are required to self-isolate or isolate for any reason remain at home during their isolation period.

Staff and students at higher risk of severe illness may attend school as long as there is no community spread of COVID-19 and they are stable. Those at higher risk include: older adults (>60 years of age) and those with chronic or immune-compromised conditions such as cancer, diabetes, renal, heart or lung disease.

Have designated isolation area for sick students. Provide parents with COVID 19 risk assessment

tool so sick students are not brought to school. Screen with infrared thermometer at door

(optional).

of 16

No mass assemblies or concerts. Safe extracurricular & volunteer activities

permitted. Full curriculum with exception of indoor wind

musical instruments and live singing and drama indoors. When there is need for music such playing the national anthem, students are encouraged to listen to the song but to avoid singing to mitigate aerosol transmission

Staggered recesses and lunches to allow small groups or eat in classrooms at spaced desks

Personal belongings in dedicated bin, under desk or staggered locker arrangement.

Indoor sports that involve no contact such as badminton, volleyball, tennis, track and field are encouraged. Sports with minimal contact such as soccer and basketball are also permitted. Avoid high contact sports such as wrestling and hockey.

Ensure to limit library interaction and encourage the use of ebooks or allow 72 hours between paper book loans from library.

Personal Protective Equipment:

NMM or face coverings recommended for students above age 2 if tolerated when unable to physically distance indoors in a prolonged contact setting (eg. traveling on school bus), otherwise not needed.

Staff to consider use of PPE based on WSCC risk assessment when physical distancing is not possible (i.e., on a bus or one-on-one teaching for greater than 15 minutes)

Teachers can consider using face shields rather than face coverings. This also limits barriers for those who are hearing impaired.

Gloves should be considered for cleaning and cooking staff.

When non-medical masks or PPE is used students and staff should receive training and reinforcement on how to properly put on and remove PPE.

of 16

Infection Prevention and Control: (See general guidance for workplaces below)

Teach, supervise and enforce strong healthy respiratory practices and handwashing

Regular handwashing and access to hand sanitizer

Enhance custodial services and regular cleaning schedules to at minimum twice daily. This includes cleaning and disinfecting high touch surfaces more frequently (i.e. desks, keyboards, screens, remotes, light switches, door handles, bathrooms, etc.).

Touch-free Consider teaching students how to clean and

disinfect their area. No communal food (i.e. buffet style). Lunch or

food programs should only provide bagged, prepackaged or single serve foods and ensure distancing is able to be maintained while accessing lunch programs.

Proper food safety should always be followed. If possible continue to enforce directional flow

so that students are entering in the lunch room one way and exiting through another to avoid overlap

No sharing of water bottles. Use water fill but no drinking from fountains directly.

No sharing of other items. No physical greetings or handshakes. Dedicated soft toys or other items not easily

cleaned in separate bag and clearly marked for individual use

Middle Schools (Grade 7-9)


Through spacing and time. Accommodate for full day re-entry Staggered pick up and drop off. Allow parents to

walk students to curb to entrust transferring of students from parents to staff members if students need additional support.

Bubble concept- no mixing of classes, with staggered entry. Consider assigned seating.


https://www.hss.gov.nt.ca/sites/hss/files/resources/healthy-respiratory-practices.pdf


https://www.hss.gov.nt.ca/sites/hss/files/resources/handwashinginfographicbig-web.pdf

of 16




Desk spacing at 1 metre separation. Physical distancing at 1 metre separation both

indoors and outdoors for middle school students aged 13 and older. Avoid physical contact.

Engineered Controls:

Physical barriers/Plexiglas. Entrance in one door and exit out another door. Defined areas to pick-up and drop off Improve ventilation (assess HVAC or open


outdoors weather permitting (open pavilion set-up).

Use visual markers to comply with 1 metre physical spacing including the restructuring of class design but must also allow teachers and support staff to maintain 6 feet of space from students

Consider enough time for students to exit the classroom and reenter without interacting with previous and/or next set of students


Minimize parents on-site Switch elder programing or guest presentations



of 16




Have designated isolation area for sick students. Provide parents with COVID 19 risk assessment

tool so sick students are not brought to school. Screen with infrared thermometer at door

(optional). No mass assemblies or concerts. Safe extracurricular & volunteer activities





Indoor sports that involve no contact such as badminton, volleyball, tennis, track and field are encouraged. Sports with minimal contact such as soccer and basketball are also permitted. Avoid

of 16

high contact sports such as wrestling and hockey.


Personal Protective Equipment:

NMM or face coverings recommended for students above age 2 if tolerated when unable to physically distance indoors in a prolonged contact setting (eg. traveling on school bus), otherwise not needed.

Staff to consider use of PPE based on WSCC risk assessments when physical distancing is not possible (i.e., on a bus or one-on-one teaching for greater than 15 minutes)








Touch-free, Consider teaching students how to clean and

disinfect their area. No communal food (i.e. buffet style). Lunch or

food programs should only provide bagged,




of 16

prepackaged or single serve foods and ensure distancing is able to be maintained while accessing lunch programs.




No sharing of other items. No physical greetings or handshakes. Dedicated items not easily cleaned in separate

bag and clearly marked for individual use.

High Schools- Grade 10-12 (back to school classes and staff)


Through spacing and time. Accommodate for full day re-entry but aim for

smaller classes and smaller circles. Consider assigned seating.

Staggered entry or pick up and drop off. Allow parents to walk students to curb to entrust transferring of students from parents to staff members if students need additional support.

Consider alternate school sites or even online classes for some subjects or extended hours when possible to minimize overcrowding in schools.

Consider computer lab access for students without internet access at home. Consider loaner laptops or refurbishing old laptops.

Keep consistent cohort when possible to avoid large mixing of students.





of 16

Desk spacing at 2 metre separation. Physical distancing at 2 metre separation both

indoors and outdoors. Avoid physical contact.

Engineered Controls:

Physical barriers/Plexiglas. Entrance in one door and exit out another. Defined areas to pick-up and drop off Improve ventilation (assess HVAC or open


outdoors weather permitting (open pavilion set-up).

Use visual markers to comply with 2 metre physical spacing including the restructuring of class design to allow teachers and support staff to maintain 6 feet of space from students

Consider enough time for students to exit the classroom and reenter without interacting with previous and/or next set of students


Minimize parents on-site Switch elder programing or guest presentations




of 16



Have designated isolation area for sick students. Provide COVID 19 risk assessment tool so sick

students are not brought to school. Screen with infrared thermometer at door

(optional). No mass assemblies or concerts. Safe extracurricular & volunteer activities





Indoor sports that involve no contact such as badminton, volleyball, tennis, track and field are encouraged. Sports with minimal contact such as soccer and basketball are also permitted. Avoid high contact sports such as wrestling and hockey.


Personal Protective Equipment: NMM or face coverings recommended for

students above age 2 if tolerated when unable to physically distance indoors in a prolonged contact setting (eg. traveling on school bus), otherwise not needed.

of 16

Staff to consider use of PPE based on WSCC risk assessments when physical distancing is not possible (i.e., on a bus or one-on-one teaching for greater than 15 minutes)








Consider teaching students how to clean and disinfect their area.

No communal food (i.e. buffet style). Lunch or food programs should only provide bagged, prepackaged or single serve foods and ensure distancing is able to be maintained while accessing lunch programs.




No sharing of other items. No physical greetings or handshakes. Dedicated items not easily cleaned in separate

bag and clearly marked for individual use.




of 16

Tools and protocol needed to be in place

WSCC workplace risk assessment

WSCC field level risk assessment

WSCC webinar

Disinfectant user guide

Enhanced cleaning checklist

Defined exclusion criteria for the following:

o When children/staff are high risk

o When children/staff should be sent home

o When parents cannot send kids

Follow the guidance for workplaces

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/guidance-schools-childcare-programs.html

https://www.hss.gov.nt.ca/sites/hss/files/resources/advisory-nwt-workplaces-offices-businesses.pdf

https://www.hss.gov.nt.ca/en/services/coronavirus-disease-covid-19/information-employers-and-businesses

https://www.hss.gov.nt.ca/sites/hss/files/resources/learn-home-make-cloth-face-mask.pdf

https://www.hss.gov.nt.ca/sites/hss/files/resources/how-use-bleach-disinfectant.pdf

https://www.hss.gov.nt.ca/sites/hss/files/resources/covid-19-disinfection-homes-camps-running-water.pdf

https://www.hss.gov.nt.ca/sites/hss/files/resources/cleaning-disinfecting-closed-work-camps.pdf

https://www.wscc.nt.ca/health-safety/covid-19

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/risk-informed-decision-making-workplaces-businesses-covid-19-pandemic.html









https://www.hss.gov.nt.ca/sites/hss/files/resources/how-use-bleach-disinfectant.pdf





https://www.wscc.nt.ca/health-safety/covid-19




ocpho backgrounder...page 1 of 16 june 30, 2020 ocpho backgrounder: coronavirus disease (covid-19),...

Documents