Health Notes

COVID-19 in B.C.: Vancouver Coastal Health cites research papers to back claim that HEPA filters not needed in schools

The Safe Schools Coalition B.C. feels that these devices will reduce the risk of transmission for students, staff, and teachers—and one study supports this viewpoint

by Charlie Smith on January 15th, 2022 at 8:43 AM
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      The Ontario government has installed stand-alone high-efficiency particulate air filters, a.k.a. HEPA filters, in all learning environments in the K-12 system.

      The Safe Schools Coalition B.C. also wants this done in B.C., which was covered earlier this month in a Straight cover story. That's because the coalition feels that these devices will reduce the likelihood of airborne COVID-19 transmission.

      However, B.C. health authorities and the NDP provincial government have refused to do this.

      Vancouver Coastal Health justified this decision in a post on its website. This has come even though a study (reported deeper in this article) shows that HEPA filters can sharply decrease the concentration of the virus in a classroom with an infected person.

      The health authority still insists that HEPA filters are not necessary because "there is no evidence that ventilation systems, in good operating condition, are contributing significantly to the spread of the virus in BC schools".

      "Like most common respiratory viruses, COVID-19 spreads primarily through respiratory droplet transmission within a short range," Vancouver Coastal Health declares. "Most commonly, students and staff who test positive for COVID-19 acquire the virus through close contact with a case at home or through their social networks.

      "Unfortunately, school-based ventilation changes are unlikely to prevent transmissions in homes and social networks," the statement continues. "In-school transmission accounts for approximately 1% of COVID-19 cases."

      This statement was updated on January 10, less than a week after the Straight's cover story appeared.

      Vancouver Coastal Health updated this statement on January 10.

      Unpublished study contradicts health authority's position

      A preprint paper on the medRxiv website has come to a radically different conclusion than B.C. public-health officials and the Ministry of Health and Ministry of Education.

      This paper, which has not yet undergone peer review, evaluated the effectiveness of different interventions against aerosol transmission of COVID-19.

      The researchers determined that one HEPA filter was as effective as two school windows being kept partly open all day during winter. In fact, a single HEPA filter led to a 2.5-fold decrease in the concentration of virus particles in a classroom of 160 square metres with one infectious individual, according to the study.

      Furthermore, it found that two HEPA filters led to a four-fold decrease in the concentration of virus particles.

      "Combined interventions (i.e., natural ventilation, masks, and HEPA filtration) were the most effective (≥ 30-fold decrease). Combined interventions remained highly effective in the presence of a super-spreader," the paper concluded.

      The lead author is Jennifer Villers, a molecular biologist, epidemiologist, and disease modeller at the University of Geneva.

      She and her fellow researchers relied on the CERN-developed COVID Airborne Risk Assessment Tool. (More information on CERN is available here.)

      Health authority calls COVID-19 a "respiratory virus"

      Vancouver Coastal Health describes COVID-19 as a "respiratory virus" even though some health experts have said that it's much more than a respiratory virus and should not be framed that way.

      "If you frame it as a respiratory virus, you have permission to call it mild, to say it’s nothing but sniffles for kids. And that’s commonly out there and I’ve heard that articulated in B.C. and elsewhere," University of Toronto public-health researcher Colin Furness said in a recent talk hosted by Protect Our Province B.C. It's a group of health-care workers and researchers trying to raise awareness about the airborne nature of COVID-19.

      "But here’s the thing: COVID, before we even get to Omicron, COVID is not a respiratory disease," he continued. "It’s a vascular disease that has an initial respiratory phase in kids and increasingly in adults. The respiratory phase is less dangerous, less acute. It looks like sniffles.

      "The problem is not the sniffles. The problem is what the virus is doing elsewhere in the body from the toes to the testes to the brain. It is causing autoimmune disease. It is causing loss of brain tissue."

      In his words, the disease has led to "brain tissue disappearing" in adults.

      "And autopsies of bodies have shown residual virus present six months after infection. Six months," Furness added. "So this virus only begins in the lungs. And if all we’re going to talk about is lungs—and I really, really dislike that framing—then we can call it mild but I’m unprepared to do that."

      Vancouver Coastal Health also claimed in its statement that COVID-19 "spreads primarily through respiratory droplet transmission within a short range".

      This interpretation of COVID-19 has come under fire from many aerosol researchers, including Jose-Luis Jimenez at the University of Colorado Boulder.

      The Straight asked Vancouver Coastal Health for a list of the peer-reviewed studies that it relied on to support its position regarding HEPA filters. (The list is at the bottom of this paper and none include the word "filter" in the title.)

      "As you’re no doubt aware, the closed peer review process for scientific literature often takes months or years between submission and publication—it’s not designed for the rapid dissemination of critical information during a rapidly evolving global pandemic," Vancouver Coastal Health public-health communications leader Deana Lancaster wrote in an email to the Straight in response to the question.

      "Accordingly, a large volume of COVID-19 research has been published on preprint servers such as www.medrxiv.org, which is sponsored by Yale University. Since you specified that you only wanted links to peer-reviewed literature, I have listed several of the most recent papers below that have helped to inform local decision-making, including one conducted in the VCH region.

      "However, given that decisions must be based on the most up-to-date research I’ve also included preprints, including another study recently conducted here. Below that, I have included a list of older studies that our medical health officers have used to guide decision-making related to schools throughout the pandemic. Since we’re now focused on measures specific to variants of concern I did not add the links. If interested, you can search by title."

      Vancouver Coastal Health sources

      Peer-reviewed

       

      Preprints

       

      Older studies

      • Boey, L., Roelants, M., Merckx, J., Hens, N., Desombere, I., Duysburgh, E., & Vandermeulen, C. (2021). Agedependent seroprevalence of SARS-CoV-2 antibodies in school-aged children from areas with low and high community transmission.
      • Bordi, L., Parisi, G., Sberna, G., Amendola, A., Mariani, B., Meoni, G. (2021). Effective screening strategy against SARS-CoV-2 on self-collected saliva samples in primary school setting: a pilot project. Journal of Infection. 
      • Buonsenso, D., De Rose, C., Moroni, R., & Valentini, P. (2021). SARS-CoV-2 infections in Italian schools: Preliminary findings after 1 month of school opening during the second wave of the pandemic. Frontiers in Pediatrics. 
      • COVID-Explained. (2020, Nov 9). Data overview: Child care centers, camps, and outbreaks
      • Ehrhardt, J., Ekinci, A., Krehl, H., Meincke, M., Finci, I., Klein, J., … Brockmann, S.O. (2020). Transmission of SARSCoV-2 in children aged 0 to 19 years in childcare facilities and schools after their reopening in May 2020, BadenWürttemberg, Germany. Eurosurveillance 25(36): pii=2001587.
      • European Centre for Disease Prevention and Control (2020, December 23). COVID-19 in children and the role of school settings in COVID-19 transmission.
      • Folkhälsomyndighete. (2020, May 27). Förekomst av covid-19 i olika yrkesgrupper.
      • Fong, M.W., Cowling, B.J., Leung, G.M., & Wu, P. (2020). Letter to the editor: COVID-19 cases among school-aged children and school-based measures in Hong Kong, July 2020. Eurosurveillance, 25(37).
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      • Gutierrez, V.C., Hassard, F., Vu, M., Leitao, R., Burczynska, B., Wildeboer, D. … Cesare, M.D. (2021). Monitoring occurrence of SARS-CoV-2 in school populations: a wastewater-based approach. 
      • Hobbs, C.V., Martin, L.M., Kim, S.S., Kirmse, B.M., Haynie, L., McGraw, S., … Flannery, B. (2020). Factors associated with positive SARS-CoV-2 test results in outpatient health facilities and emergency departments among children and adolescents aged <18 years — Mississippi, September–November 2020. Morbidity and Mortality Weekly Report, 69, 1925-1929.
      • Hommes, F., van Loon, W., Thielecke, M., Abramovich, I., Lieber, S., Hammerich, R., … Mockenhaupt, F.P. (2020).
      • SARS-CoV-2 infection, risk perception, behaviour, and preventive measures at schools in Berlin, Germany, during the early post-lockdown phase: A cross-sectional study. International Journal of Environmental Research and Public Health, 18(5), 2739.
      • Institut national de santé publique du Québec. (2021, April). Vigie de la COVID-19 dans les services de garde éducatifs à l’enfance - Avril 2021.
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      • Update 17: August 12, 2021 4
      • Kowalsky, R. H., Fine, S., Eisenberg, M. (2021). Exclusion of SARS-CoV-2 from two Maine overnight camps JulyAugust 2020. Disaster Medicine and Public Health Preparedness. 
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      • Lewis, S.J., Dack, K., Relton, C.L., Munafò, M.R., & Smith, G.D. (2021). Risk of death among teachers in England and Wales during the Covid19 pandemic.
      • Llupià, A., Borràs-Santos, A., Guinovart, C., Utzet, M., Moriña, D., & Puig, J. (2021). SARS-CoV-2 transmission in students of public schools of Catalonia (Spain) after a month of reopening. PLoS One, 16(5), e0251593.
      • Ludvigsson, J.F., Engerström, L., Nordenhäll, C., & Larsson, E. (2021). Open schools, COVID-19, and child and teacher morbidity in Sweden. The New England Journal of Medicine, 384, 669-671.
      • Manny, E., Carroll, A., Charlton, C., Robinson, J., Subbarao, P., Azad, M.B., … Mandhane, P.J. (2020). Increased mask use and fewer gatherings associated with lower SARS-CoV-2 seropositivity among young school-age children. 
      • McCluskey, N. (2021). Private schooling after a year of COVID-19: How the private sector has fared and how to keep it healthy. 
      • Nachman, S., Brauner, G., Beleck, A., & Handel, A.S. (2021). Day camp in the time of COVID-19: What went right? 
      • National Institute for Public Health and the Environment (RIVM). (2021, March 19). Children, school and COVID-19.
      • Otte im Kampe, E., Lehfeld, A. S., Buda, S., Buchholz, U., & Haas, W. (2020). Surveillance of COVID-19 school outbreaks, Germany, March to August 2020. Eurosurveillance 25(38).
      • Pollock, N.R., Berlin, D., Smole, S.C., Madoff, L.C., Henderson, K., Larsen, E. … Lennon, N.J. (2021). Implementation of SARS-CoV2 screening in K-12 schools using in-school pooled molecular testing and deconvolution by rapid antigen test. 
      • Pray, I., Kocharian, A., Mason, J., Westergaard, R., & Meiman, J. (2021). Trends in outbreak-associated cases of COVID-19 — Wisconsin, March–November 2020. Morbidity and Mortality Weekly Report, 70(4), 114-117.
      • Robert Koch Institute. (2020, Nov 30). Coronavirus disease 2019 (COVID-19) daily situation report of the Robert Koch Institute.
      • Rytter, M.J.H., Nygaard, U., Mandic, I.N., Glenthøj, J.P., Schmidt, L.S., Cortes, D. … Kristensen, K. (2021). Prevalence of SARS-CoV-2 antibodies in Danish children and adults. The Pediatric Infectious Disease Journal, 40(4), e157-e159.
      • Smith-Norowitz, T.A., Kohlhoff, S., Hammerschlag, M. R. (2021). Coronavirus disease 2019 prevalence rates in reopened private schools in New York City: Impact of diagnostic methods. Acta Paediatrica. 
      • Smith-Norowitz, T.A., Norowitz, Y.M., Kohlhoff, S., & Hammerschlag, M.R. (2021). SARS-CoV-2 positivity rates are lower in school compared with local rates in Brooklyn, New York. Acta Paediatrica. 
      • Szépfalusi, Z., Schmidthaler, K., Sieber, J., Kopanja, S., Götzinger, F., Schoof, A. … Frischer, T. (2021). Lessons from low seroprevalence of SARS‐CoV‐2 antibodies in schoolchildren: a cross‐sectional study. Pediatric Allergy and Immunology. 
      • Thompson, D.A., Abbasizanjani, H., Fry, R., Marchant, E., Griffiths, L., Akbari, A., … Lyons, R. (2021). Staff-pupil SARS-CoV-2 infection pathways in schools: a population level linked data approach. 
      • Ulyte, A., Radtke, T., Abela, I.R., Haile, S.R., Blankenberger, J., Jung, R., … Kriemler, S. (2020). Variation in SARSCoV-2 seroprevalence in school-children across districts, schools and classes. 
      • Varma, J.K., Thamkittikasem, J., Whittemore, K., Alexander, M., Stephens, D.H., Arslanian, K. … Long, T.G. (2021).
      • COVID-19 infections among students and staff in New York City public schools. Pediatrics, 147(5). 
      • Villani, A., Coltella, L., Ranno, S., Bianchi di Castelbianco, F., Murru, P.M., Mazzone, T. … Concato, C. (2021). School in Italy: a safe place for children and adolescents. Italian Journal of Pediatrics, 47, 1-3.
      • Zimmerman, K., Akinboyo, I.C., Brookhart, A., Boutzoukas, A.E., McGann, K., Smith, M.J., … Benjamin Jr., D.K. (2020). Incidence and secondary transmission of SARS-CoV-2 infections in schools. Pediatrics. 
      • Zinszer, K., McKinnon, B., Bourque, N., Pierce, L., Saucier, A., Otis, A. … Quach, C. (2021). Seroprevalence of antiSARS-CoV-2 antibodies among school and daycare children: Baseline results from a cohort study in Montreal, Canada. 
      • Aiano, F, Mensah, A., McOwat, K., Obi, C., Vusirikala, A., Powell, A. … Saliba, V. (2021). COVID-19 outbreaks following full reopening of primary and secondary schools in England: retrospective, cross-sectional national surveillance. The Lancet Regional Health- Europe, 6, 100120.
      • Aizawa, Y., Shobukawa, Y., Tomiyama, N., Nakayama, H., Takahashi, M., Yanagita, J. … Saitoh, A. (2021). Coronavirus disease 2019 cluster originating in a primary school teachers’ room in Japan. 
      • Alberta Health Services. (2020, August 7). COVID-19 scientific advisory group rapid evidence report.
      • Armann, J.P., Kirsten, C., Galow, L., Kahre, E., Haag, L., Dalpke, A. (2021). SARS-CoV-2 transmissions in students and teachers: seroprevalence follow-up study in a German secondary school in November and December 2020. BMJ Paediatrics Open, 5, e001036.
      • Armann, J.P., Unrath, M., Kirsten, C., Lück, C., Dalpke, A.H., & Berner, R. (2020). SARS-CoV-2 IgG antibodies in adolescent students and their teachers in Saxony, Germany (SchoolCoviDD19): Persistent low seroprevalence and transmission rates between May and October 2020. 
      • Belavic, A., Dimnjakovic, J., Istvanovic, A., Svajda, M., Poljicanin, T., & Simetin, I.P. (2021). Re-opening schools in Croatia did not have a negative impact on children under 14, but it could not be ruled out in older children. Acta Paediatrica. 
      • Blaisdell, L.L., Cohn, W., Pavell, J.R., Rubin, D.S. & Vergales, J.E. (2020). Preventing and mitigating SARS-CoV-2 transmission – four overnight camps, Maine, June-August 2020. Morbidity and Mortality Weekly Report 69(35), 1216-1220.
      • Bosslet, G. T., Pollak, M., Jang, J.H., Roll, R., Sperling, M., & Khan, B. (2021). The effect of in-person primary and secondary school instruction on county-level SARS-CoV-2 spread in Indiana. Clinical Infectious Disease, ciab306.
      • Brandal, L.T., Ofitserova, T.S., Meijerink, H., Rykkvin, R., Lund, H.M., Hungnes, O., … Winje, B.A. (2021). Minimal transmission of SARS-CoV-2 from paediatric COVID-19 cases in primary schools, Norway, August to November 2020. Eurosurveillance, 26(1), 1-6.
      • Buja, A., Paganini, M., Cristofori, V., Baldovin, T., Fusinato, R., Bocucuzzo, G., … & Parpinel, M. (2021). Opening schools and trends in SARS-CoV-2 transmission in European countries. 
      • Buonsenso, D. & Graglia, B. (2021). High rates of SARS‐CoV‐2 transmission in a high‐school class. Journal of Paediatrics and Child Health, 57(2), 299-300.
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      • Oslo: Folkehelseinstituttet/Norwegian Institute of Public Health.
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      • Crowe, J., Schnaubelt, A. T., Schmidt-Bonne, S., Angell, K., Bai, J., Eske, T. … Broadhurst, M. J. (2021). Pilot program for test-based SARS-CoV-2 screening and environmental monitoring in an urban public school district. 
      • Danis, K., Epaulard, O., Bénet, T., Gaymard, A., Campoy, S., Bothelo-Nevers, E., … Saura, C. (2020). Cluster of coronavirus disease 2019 (COVID-19) in the French Alps, February 2020. Clinical Infectious Diseases 71(15): 825- 832.
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      • Doron, S., Ingalls, R.R., Beauchamp, A., Boehm, J., Boucher, H.W., Chow, L.H. … Ciaranello, A. (2021). Weekly SARS-CoV-2 screening of asymptomatic students and staff to guide and evaluate strategies for safer in-person learning. 
      • Doyle, T., Kendrick, K., Troelstrup, T., Gumke, M., Edwards, J., Chapman, S., Propper, R., … Blackmore, C. (2021). COVID-19 in primary and secondary school settings during the first semester of school reopening – Florida, August – December 2020. Morbidity and Mortality Weekly Report, 70(12), 437-441.
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