Sick Kids update shows that school closures have significant adverse health and welfare consequences for children and youth

BY PAUL JUNOR

Premier Doug has relied on a team of experts to guide its back-to-school plan. Sick Kids and Unity Health Toronto, and a diverse group of experts based it on recommendations published on July 29^th, 2020. The document titled, “Updated COVID-19: Guidance for School Reopening.” It states that the ultimate goal was, “bringing children and youth back to school for in-person, full-time learning, with appropriate risk-mitigation strategies to ensure everyone’s safety.”

The importance of this document is that, “it highlights the need to consider the epidemiology of COVID-19 in decision-making. It provides recommended health and safety measures, with age and developmental considerations, to support schools in keeping students, staff and their families’ safe. The authors stress that keeping schools open safely will be facilitated by low rates of community transmission and everyone has a significant role in adhering to public health recommendations to keep community transmission as low as possible. It also emphasizes the importance of monitoring the impact of school reopening on the transmission.”

It is interesting that two of the quick facts that it mentioned are that world-wide, children and young-people account for less than 5-10% of SARS- CoV-2 asymptomatic infections, and in Canada as of July 26^th, 2020 only 7.5% were individuals between the age of 0 and 19. It also notes that kids less than 10 years of age have a higher chance of not spreading the virus but recognizes that many of them may not show any symptoms or only mild ones.

The overriding focus is, “school closures have significant adverse health and welfare consequences for children and youth. Some of these unintended consequences include adverse impacts on children’s behaviour and mental health, food insecurity and increased risk of family violence.”

The document quotes Dr. Evdokia Anagnostou who states, “the gap in learning support during the lockdown has significantly impacted children with special needs. We know that families with special needs are reporting worsening mood, anxiety, inattention, and irritability since the onset of school closures and other emergency measures.”

 On Thursday, January 21^st, 2021 the Hospital for Sick Children released its updated guidance document. It can be accessed at

sickkids.ca/en/news/archive/2021/covid19  It recommends the stoppage of in-person learning as the last thing that should be considered.

The document states,“in considering decisions about regional closure of schools for in-person learning, it is important to balance the health risks of SARS-CoV-2 with the significant harms of school closure on children’s physical, developmental health, mental health and learning. Given the significant negative impact that the initial prolonged school closure (to in-person learning) had on children and youth, it is our strong opinion that an in-person school model with robust application of the recommended interventions is the best option from an overall health learning perspective for children of all ages allowing for consistency, stability and equity.”

 The most important updates include:

• Testing recommendations for asymptomatic students considerations for asymptomatic testing
• Robust physical distancing and NNM use, particularly for high school and middle school students for the highest risk/ epidemiology regions
• Emphasis on cohorting rather than strict enforcement for younger students
• Update the section on mental health awareness, and support for all children