Keeping schools open during COVID-19 pandemic: B.C. public health physicians and child health specialists

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      This open letter was sent on June 3 by Vancouver Coastal Health from over 60 public health physicians and child health specialists:

      One year ago in British Columbia, schools were preparing for limited re-entry of students who had been learning online since the end of spring break amid the province’s first wave of COVID-19. Survey data from this period gave an early indication of the detrimental impacts of school closures we’ve now observed around the world: impaired learning for many students, decreased social connection, and stress for families.

      The return to classes in September came with both benefits for students, and accompanying fears that schools could be drivers of community transmission. But thanks to the hard work of schools, staff, parents and caregivers, and students, B.C. was able to achieve a collective goal: schools remained safely open in the second and third waves to fulfill their essential function in the intellectual and social growth of students.

      Over the past year we have learned a great deal about COVID-19 and the risk in our schools. We now know that, although students and staff do test positive for COVID-19, they most often acquire the virus from the community at rates that mirror community transmission. The vast majority of the time these are isolated events with no onward transmission in the school. Contact tracing studies conducted in Ireland, Singapore, Wisconsin, England, North Carolina, and Utah, among others, have consistently demonstrated low rates of in-school transmission. In B.C., Vancouver Coastal Health and Fraser Health have reported similar results. Asymptomatic viral testing and seroprevalence studies addressing the potential for “silent” asymptomatic spread in Italy, Norway, Australia, and B.C. have similarly suggested that widespread COVID-19 transmission is rare in the school setting.

      The percentage of exposures in school leading to transmission events has remained low even as we’ve seen a shift in the circulating variants of COVID-19 in B.C. This means that the safety measures in schools – including accessible testing for those who need it, keeping kids home when sick, practicing good hand hygiene, and restricting entry—continue to be effective even against variants of concern. In B.C.’s third wave, while close contacts of COVID-19 cases were isolated, broad school closures were not implemented, and maintaining consistent in-school education did not prevent public health measures from effectively decreasing community transmission. Perhaps most importantly, B.C. has been able to keep schools safely open for in-person learning, while still maintaining one of the lowest COVID-19 mortality rates of any larger jurisdiction in North America.

      We’ve also learned more this year about how closing schools hurts children and families, especially those who are the most vulnerable. For many students, schools are important for learning and social development. For vulnerable children, schools can be a lifeline – the site of access to healthy and consistent meals, a place of connection to trusted adults, and, for some, a source of stability in chaotic lives. School closures also place disproportionate burdens on women and lone parents who shoulder the responsibility of supporting childcare and online learning.

      Finally, in recent months we’ve seen how effective vaccination against COVID-19 is at cutting community transmission and protecting those at risk of severe disease. In Prince Rupert in Northern British Columbia, where more than 60 percent of adults were vaccinated in March as part of a whole-of-community campaign, rates of new COVID-19 cases have dropped more than 90 percent since their peak. Cases in other communities prioritized for vaccination in B.C., such as the town of Whistler, have also seen substantial reductions in cases. With many staff, parents and caregivers, and children now eligible for vaccination, we will collectively be able to build on our ability to protect the vital role schools play in a healthy, equitable society. By the fall, we can also look forward to a return to many of the extracurricular activities that keep students engaged at school and connected to their peers.

      We have shown that, even during a pandemic, students’ education can be safely prioritized; vaccination will help us cement that success and support the school experience that children, youth, and families deserve.

      Find out how to get vaccinated in your province by visiting www.canada.ca/covid-vaccine. If you’ve already been vaccinated, you can help by reaching out to others in your community who might need help to register. Covidquestions.ca has answers to common questions you might hear from family and friends who have yet to be vaccinated.

      Alex Choi MD MHSc CCFP FRCPC
      Medical Health Officer
      Vancouver Coastal Health

      Ariella Zbar MD CCFP MPH MBA FRCPC
      Medical Health Officer
      Fraser Health Authority

      Ashley Roberts, MD, M.Ed., FRCPC
      Division Head, Pediatric Infectious Diseases
      Department of Pediatrics, UBC

      David Goldfarb, MD, FRCPC
      Clinical Associate Professor
      Department of Pathology and Laboratory Medicine, UBC

      Manish Sadarangani, BM BCh FRCPC DPhil
      Associate Professor, Department of Pediatrics, UBC
      Director, Vaccine Evaluation Center, BC Children’s Hospital Research Institute

      Christine A. Loock, MD, FRCPC, DABP
      Medical Director and Specialist Lead, RICHER Program,
      Department of Pediatrics, UBC

      Susan Wakeham, MD, FRCPC
      Pediatric Infectious Disease Fellow
      University of British Columbia

      Esther Lee, MD, FRCPC
      Clinical Instructor, Division of General Pediatrics and Division of Pediatric Palliative Medicine
      Department of Pediatrics, UBC

      Matt Carwana, MD, MPH, FRCPC
      Clinical Instructor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Alison Lopez, MD, FRCPC
      Pediatric Infectious Diseases physician

      Raina Fumerton, MD, MPH, FRCP
      Public Health and Preventive Medicine Specialist

      Rakel Kling, MD, MSC, MPH, FRCPC
      Public Health and Preventive Medicine Specialist

      Mel Krajden, MD, FRCPC
      Medical Director, BCCDC Public Health Laboratory
      Professor, Dept. of Pathology and Laboratory Medicine, UBC

      Jocelyn Srigley, MD, MSc, FRCPC
      Clinical Assistant Professor, Department of Pathology and Laboratory Medicine, UBC

      Sandra Allison, MD, MPH, CCFP, FCFP, FRCPC
      Medical Health Officer and Public Health and Preventive Medicine Specialist
      Vancouver Island Health Authority

      Julie Bettinger, PhD, MPH
      Professor, Pediatrics, UBC
      Vaccine Evaluation Center, BC Children’s Hospital Research Institute

      Allison A. Eddy, MD, FRCPC, CAHS
      Professor and Head, UBC Department of Pediatrics

      Geoff McKee, MD, MPH, FRCPC
      Medical Director, Population and Public Health
      BC Centre for Disease Control

      Trevor Corneil, MD, MHSc, FCFP, FRCPC
      Clinical Professor, School of Population and Public Health
      University of British Columbia

      Laura Sauve, MD MPH FRCPC
      Clinical assistant Professor, Division of Pediatric Infectious Diseases
      UBC Department of Pediatrics

      Ghada Al-Rawahi, MD, FRCPC
      Clinical Associate Professor, Department of Pathology and Laboratory Medicine, UBC

      Silvina Mema MD, MSc, FRCPC
      Medical Health Officer, Interior Health

      Erin Peebles, MD, FRCPC
      Clinical Assistant Professor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Alison Lee, MD, FRCPC
      Pediatric Emergency Medicine Physician
      Clinical Instructor, Department of Pediatrics, UBC

      Matthew Chow, MD, FRCPC
      Child and Adolescent Psychiatrist
      Clinical Instructor, Department of Psychiatry
      University of British Columbia

      Tommy Gerschman, MD, MSc, FRCPC
      Pediatric Rheumatologist and Pediatric Sports Medicine
      Clinical Instructor, Department of Pediatrics, UBC

      Sarah Freedman, MD, MES, FRCPC
      Clinical Instructor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Erik Swartz, MD, MSc, FRCPC, CCPE
      Clinical Associate Professor
      Department of Pediatrics, UBC

      Samara Laskin, MD, FRCPC
      Clinical Instructor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Tom McLaughlin, MD, MPP, FRCPC, FAAP
      Clinical Assistant Professor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Catherine Biggs, MD, MSc, FRCPC
      Clinical Assistant Professor, Division of Allergy & Immunology
      Department of Pediatrics, UBC

      Jennifer Retallack, MD, FRCPC
      Clinical Instructor, Division General Pediatrics
      Department of Pediatrics, UBC

      Dianna Louie, MD, FRCPC, FAAP
      Clinical Assistant Professor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Robert Lehman, MD, CCFP, MClSc, FCFP
      Clinical Assistant Instructor, Division of Family Medicine, UBC
      Division of Family Practice, Sunshine Coast

      Hana Mitchell, MD, MSc, FRCPC
      Clinical Assistant Professor
      Pediatric Infectious Diseases | Pediatrics
      The University of British Columbia | BC Children's Hospital

      Michaela Remington, MD, FRCPC
      Clinical Assistant Professor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Aven Poynter, MD, FRCPC
      Community Paediatrician, Langley
      Clinical Assistant Professor, Department of Paediatrics, UBC

      David Smith, MD, FRCPC
      Child and Adolescent Psychiatrist, Vernon
      Medical Director C&A Psychiatry, IHA

      Kirsten Miller, MD, FRCPC
      Community Paediatrician, Prince George
      Clinical Assistant Professor, Paediatrics, UBC

      Alexis Crabtree, MD, MPH, PhD
      Resident Physician in Public Health and Preventive Medicine
      School of Population and Public Health, UBC

      Wilma Arruda, BSc, BEd, MD, FRCPC
      Community Pediatrician, Nanaimo
      Clinical Assistant Professor, Pediatrics, UBC

      Mark Bigham, MD, FRCPC
      Medical Health Officer
      Fraser Health Authority

      Gwyneth McIntosh, BScN, MN, NP(F)
      Family Nurse Practitioner
      RICHER Social Pediatrics Program
      BC Children’s Hospital

      Claire Seaton BM, BCh, MRCPCH, FRCPC
      Clinical Assistant Professor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Dominique Eustace, MD, FRCPC
      Locum, Division of General Pediatrics
      Locum, Division of Child Development and Rehabilitation
      BC Children’s Hospital

      Nita Jain, MD FRCPC
      Clinical Assistant Professor, Division of General Pediatrics
      Department of Pediatrics, UBC

      Denise Hanson, MN
      Pediatric Nurse Practitioner
      RICHER Social Pediatrics Program
      BC Children’s Hospital

      Albert de Villiers, MBChB, MMed
      Chief Medical Health Officer
      Interior Health

      Shobhit Maruti, MD MPH (OEM) PRCPC DABPM
      Medical Health Officer
      Interior Health

      Sue Pollock, MD MSc FRCPC
      Medical Health Officer
      Interior Health

      Karin Goodison, MD MPH FRCPC
      Medical Health Officer
      Interior Health

      Carol Fenton, BHSc MD MSc FRCPC
      Medical Health Officer
      Interior Health

      Réka Gustafson, MD MHSc, FRCPC
      VP Public Health and Wellness and Deputy Provincial Health Officer
      Provincial Health Services Authority

      Sim Grewal, MD FRCPC
      Medical Director, Pediatric Emergency Medicine
      Clinical Associate Professor, Department of Pediatrics, UBC

      Jane Buxton MBBS MHSc FRCPC
      Professor UBC School of Population and Public Health
      Physician Epidemiologist, BC Centre for Disease Control

      Meghan Gilley, MD FRCPC
      Pediatric Emergency Medicine
      Clinical Instructor, Department of Pediatrics, UBC

      Althea Hayden, MDCM MPH FRCPC
      Medical Health Officer
      Vancouver Coastal Health

      Harold (Hal) Siden, MD, MHSc, FRCPC
      Clinical Professor and Division Head, Pediatric Palliative Medicine
      Department of Pediatrics, UBC

      Naomi Dove MD MPH FRCPC
      Public Health & Preventive Medicine Consultant Physician, Office of Provincial Health Officer
      Clinical Assistant Professor, UBC School of Population & Public Health

      Veronic Clair, MD, MSc in Health Administration, CCFP, FRCPC, PhD
      Public Health and Preventive Medicine Specialist and Addiction Medicine Consultant
      Physician Epidemiologist, Communicable Diseases and Immunization Service, BC Centre for Disease Control

      Mary Bennett, MD FRCPC
      Clinical Professor and Associate Head, Education
      Department of Pediatrics, UBC

      Jasmine Allaire, MDCM FRCPC
      Pediatric Emergency Medicine
      Clinical Instructor, Department of Pediatrics, UBC

      Marie-Claude Grégoire, MD MSc FRCPC
      Clinical Instructor, Division of General Pediatrics and Division of Pediatric Palliative Medicine
      Department of Pediatrics, UBC

      Mark Lysyshyn MD MPH FRCPC
      Deputy Chief Medical Health Officer, Vancouver Coastal Health
      Clinical Assistant Professor, University of British Columbia

      Patricia Daly MD, FRCPC
      Chief Medical Health Officer, Vancouver Coastal Health
      Clinical Professor, School of Population and Public Health, UBC

      Tessa Diaczun, MN NP (Pediatrics)
      Pediatric Nurse Practitioner
      BC Children’s Hospital

      Carmen Tait, MD FRCPC
      Pediatric Emergency Medicine
      Clinical Instructor, Department of Pediatrics, UBC

      Karen Black, MD FRCPC
      Community Pediatrician, Vancouver
      Pediatric Emergency Medicine
      Clinical Associate Professor, Dept of Pediatrics UBC

      Simi Khangura, MD FRCPC
      Pediatric Emergency Medicine
      Clinical Associate Professor, Department of Pediatrics, UBC

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