The saying goes, “hope for the best, but prepare for the worst”; schools are set to reopen in a few weeks, but are they truly prepared for what is yet to come? Many have been outspoken about the preventative measures provincial governments must implement in schools, such as mandatory masking, increased ventilation, smaller class sizes, and cohorting students with their teachers. However, another important question to ask is, what are the contingency plans in place to prevent an outbreak if a student, teacher, or staff tests positive for COVID-19?

Once schools reopen, the occurrence of COVID-19 cases is inevitable according to public health officials Dr. Vinita Dubey and Dr. Brent Moloughney. Both have stated that they expect to see school-related cases. This unavoidable reality has already been witnessed in parts of Canada. In early June, an elementary school that remained open in Trois-Rivières, Québec, had nine of 11 students in a class test positive for COVID-19 despite using prevention measures, such as operating at half-capacity, having hand washing reminders and using floor markings to encourage physical distancing. More recently, three childcare centers in Ottawa are facing outbreaks, even though the staff and children underwent mandatory temperature screenings each day before entering the facility. These events can be explained by a recent study published in the Journal of Pediatrics titled, “Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses”. The researchers found that infected children, even those who are asymptomatic, had significantly higher levels of COVID-19 in their airways, compared to hospitalized adults. Since increased transmissibility of COVID-19 is associated with higher viral loads, it suggests that children may play a larger role in the spread of this virus than previously thought. The certainty of school-related cases, combined with these findings that suggest children silently spread COVID-19, indicates that planning for school outbreaks is a necessity. Many provinces have outbreak management plans, however, they fall short in providing clear guidelines for many of these areas: 1) screening, 2) setting up isolation rooms and safely dealing with symptomatic students or staff, 3) contact tracing and informing the school community (i.e. parents, caregivers, students, teachers, and staff) of active cases, 4) returning to school after exposure, and 5) determining a case threshold for school closure.

Implementing screening tools is an important first step in outbreak management. It informs school members (i.e. parents, caregivers, students, teachers & staff) about the symptoms of COVID-19 and determines their proximity to high-risk areas; therefore prompting them to act as the first barrier against virus spread by staying home if exposed or symptomatic. However, it is important that this self-screening occurs daily and before entering the school or taking the school bus. Most provinces provide a screening checklist to their members and require it to be completed every day before school, except for Quebec and Saskatchewan. Instead, Saskatchewan is calling on each school division to develop their own screening policy, while Quebec may implement testing of asymptomatic individuals in certain schools.

Even though most provinces are using self-screening as their first step, some provinces are implementing additional measures. This stems from concerned health professionals, such as Dr. Andrew Morris, who say that self-screening is not enough, and that provinces should instead implement syndromic or pooled surveillance. Syndromic surveillance refers to absent kids being assessed, tested and isolated. Pooled surveillance is when entire classrooms are tested randomly to detect unnoticeable COVID-19. So far, Ontario plans to supply schools with additional public health nurses to conduct screening & testing, while P.E.I plans to provide schools with thermometers to check anyone showing signs of illness. Going a step further, Saskatchewan is the only province that takes an innovative approach to testing and reporting COVID-19 data. They have developed a testing innovation committee that will evaluate the latest testing options, concentrating on measures that are less invasive and more comfortable for children. They are also implementing targeted testing across school divisions, and a targeted monitoring program where students can participate in voluntary testing at participating schools. Those schools will be chosen based on population density, grade level, or surges in community COVID-19 levels. It is important to note that currently no province has outlined a plan for rapid testing as part of their back-to-school guidelines.

A guideline on how to safely deal with symptomatic students or staff on school grounds is critical. The plan should include a mandatory isolation room or predetermined “COVID-19 area,” a supervision plan for symptomatic children, a PPE procedure for the isolation room, a timeline for informing parents about taking home symptomatic children, and a disinfecting protocol for the contaminated areas. Most provinces have detailed plans that cover this topic, except for Ontario, British Columbia, New Brunswick, and Prince Edward Island. British Columbia and New Brunswick have the least comprehensive guidelines. Schools in British Columbia are not required to prepare isolation rooms, a parent notification procedure, a supervision plan, or an explanation of PPE usage. New Brunswick’s plan does not include preparation of isolation rooms, a supervision plan, an explanation of PPE usage, or a disinfecting protocol. Moreover, Ontario is missing a timeline for parent notifications, and a disinfecting protocol, while P.E.I included every step, but omitted a supervision plan. In contrast, Quebec went a step further to include PPE emergency kits in the isolation rooms, that contain a procedure mask, visor, smock (gown), gloves and alcohol-based hand sanitizer.

After a positive case is confirmed at a school, contact tracing is the next important step in containing the spread of COVID-19. This is completed by public health officials, who are informed by school administrators with all the necessary records (i.e. seating charts, cohort groups, approved visitors, etc.). Another important responsibility is to inform the school community of active cases, allowing them to make the best decision for them and their families. Prince Edward Island and Manitoba have the best policies in this area because they include a description of what information schools should be recording, state that public health should be immediately notified by the school about any potential cases, outline public health’s role in contact tracing, and state that the school community will be notified when there is any positive case. Other provincial plans do not go into as much detail. For example, Alberta and Quebec do not provide enough guidance about the information that schools should be recording, while Ontario and Nova Scotia are not clear if they will be informing the school community about positive cases. British Columbia, Newfoundland & Labrador and New Brunswick neither explain what records should be kept, nor state if the school community will be updated. Finally, Saskatchewan is relying on individual school boards to create their own individual policies.

Developing a criterion for when students or staff can return to school, following self-isolation, is important because it provides clarity and consistency for the entire school community. Unfortunately, more than half of the provinces provide no clear guidelines and rely on public health officials to evaluate individuals on a case-by-case basis. The provinces that have detailed plans include Alberta, Quebec, Prince Edward Island and Newfoundland & Labrador. Also, no province requires a proof-of-negative COVID-19 test before returning to school.

Lastly, a good outbreak management plan should outline the maximum number of cases that yields a school shut down, allowing school administrators to operate using a province-set standard. Unfortunately, the majority of provinces do not set clear standards for school closure, and instead rely on individual evaluations from public health officials. However, Newfoundland & Labrador, Alberta, Saskatchewan, and Nova Scotia laid out a school closure plan that would be implemented by public health officials.

These are the main categories for a well-designed outbreak management plan. Even though many provinces have covered most of these areas, there are still many gaps that need to be filled before the upcoming school year. Please note that the information outlined in this op-ed is based on the current back-to-school regulations of each province. This information is subject to change due to the uncertainty of the matter.