What parents need to know as kids go back to school amid the fourth wave

The best way for parents to protect their kids against COVID is to get vaccinated themselves.

Parents of young children apparently have a lower immunization rate," Ontario's chief medical officer of health Dr. Kieran Moore said at a COVID briefing Tuesday. Our youngest Ontarians - those 11 and younger - don't have a choice. There is no vaccine available to them yet. It's our collective responsibility to ... surround them with those who are vaccinated. ... This is one of the best ways to protect them."

Schools are returning to in-person learning in less than two weeks amid a fourth wave fuelled by the aggressive Delta variant and the unvaccinated.

With increasing anxiety among many parents, two doctors give an idea of what the school year will bring.

Dr. Martha Fulford is an infectious disease specialist and associate professor at McMaster University and Dr. Barry Pakes is the director of the public health and preventive medicine residency program at the University of Toronto's Dalla Lana School of Public Health.

With cases already rising, what will happen when school starts?

Pakes: We do expect to see a continuation of increasing cases and where specifically that goes is really dependent on us."

Fulford: It is very important to remember that case counts will no longer be the important metric we will need to follow. The focus needs to be on hospitalizations. The vaccines have been very effective at preventing severe disease."

How big is the risk of going back to school, particularly for those under 12?

Pakes: Any time we have people who are unvaccinated getting together, especially with the Delta variant, it is somewhat of a risk that they are going to be infected ... Really the most important thing is that we know a lot of transmission happens in households. ... If everybody who can be vaccinated in their family ... are vaccinated it's much less likely that kids bring infection into schools and into their cohorts."

Fulford: SARS-CoV-2 has never been, and still is not, a virus that causes severe disease in children and youth ... It is important to put the risk in perspective. We should be very reassured by knowing that kids in all other provinces in Canada were kept in school with no adverse effects. Even more important, we can look at countries in Europe where schools were open during their peak of Delta and the kids are fine."

Why has there been lower vaccine uptake among the young?

Pakes: They were the last to be eligible ... The perceived risk - as well as the actual risk based on what we've seen over the past year and a half - is lower among that age and they just feel that it's less important for them to be vaccinated. Then of course there is the whole social dynamic of being skeptical of authority."

In the end, they need to get vaccinated," said Pakes. We need to make it the easiest thing that they can do and also put some barriers to them not doing it ... Places of employment and especially places of education - universities and colleges - putting in policies that don't allow them to return unless they are vaccinated."

How important is it for parents to know if teachers are vaccinated?

Pakes: I think every parent would say they have a moral right to know ... Of course, there are also the legal and the moral rights of teachers to privacy. Ultimately this is something that is changing very quickly ... We really have moved forward with the cases increasing in recognizing ... we have to compromise somewhat on those individual rights of privacy in order to make sure the collective is safe. I think that is going to continue to evolve."

Fulford: It is private medical information. Having said that, it is important for any teacher who is at high risk to be vaccinated as it protects his or her health."

Is enough being done to get schools as ready as possible?

Pakes: I can understand why ... everyone feels that everything is not quite ready for school and it is somewhat last minute. A lot of that is a product of the fact things are just really dramatically changing ... Overall, I think we're in a good place in Ontario. I have five kids and I don't have great concerns about them returning to the classroom and I'm excited for them to do that in person."

Fulford: Schools in Ontario are actually doing a lot more than is being done anywhere else in Canada - if anything, the question should be whether these measures are even needed or can be justified at this point. I would focus on the overall health and well-being of our children and remember that the harms currently being experienced by so many children are not as a result of COVID but rather of prolonged school closures and social isolation. Kids need to be allowed to be kids."

What is missing from the back-to-school plan?

Fulford: An exit strategy. With most adults vaccinated and with the decoupling of cases from severity, we need a go-forward plan on how to coexist with COVID as one of our seasonal respiratory viruses."

Pakes: The fact that 25 per cent of schools are independent - not in the public or Catholic system. Some of those are fancy private schools with a lot of resources but many, many of them are not ... Some of those schools are developing great protocols and others are not. I think it's important to make sure those schools are supported as well as all the other schools."

How do families determine how to make decisions about risks?

Pakes: It is a difficult discussion ... People are going to really understand their risk and benefit calculation very differently. As a parent myself but also as someone who works in public health, I always look at the population level risk. I know that cases are going to increase and there are going to be outbreaks in schools and kids are going to get sick - some of them very severely - over the next several months ... But I know that the likelihood of my child being infected or severely affected is very, very, very small, so I do have confidence in the schools."

Is it safe to take part in extracurriculars and sports?

Fulford: Safe. The importance of extracurricular activities cannot be overstated - we need to do absolutely everything we can to return our kids to a normal life."

Pakes: It is generally safe but certainly that is one of those areas where you can have significant amounts of spread between schools and between classes ... I certainly feel very strongly that many of these clubs, extracurriculars, different sports leagues across Ontario really need to have policies with respect to vaccination both for coaches and for competitors. I think it's reasonable for them in many cases to exclude people who are not vaccinated ... I think that is going to be something we're going to be seeing over the next couple of weeks."

Can kids have play dates?

Fulford: Yes. Children and youth who are ill with anything should, of course, be kept home until they are asymptomatic."

Pakes: That's going to be really challenging to do in between cohorts ... The idea of cohorting is that they are not mixing with each other and certainly the more kids mixed together, the more chance there is for outbreaks that span more than one cohort ... It's still a good idea to do it outdoors and ... to do it masked ... Kids above the age of 12 who can be vaccinated, I would say that it's safe to do so if everybody is vaccinated."

What should be avoided?

Pakes: Larger gatherings - weddings, sporting events and birthday parties with 75 to 100 people - is where we are seeing some transmission ... I think it really is important for every single individual who is going to be attending those events ... that you really want to restrict them to vaccinated people only ... As a parent if you're not sure that everyone at some kind of gathering like that is going to be vaccinated than I wouldn't attend."

What can parents do to minimize risk?

Pakes: Getting vaccinated yourself and ensuring that everyone in your household is vaccinated ... Just simply making sure you and your child are adhering to the guidelines of the school."

Fulford: The more adults that are vaccinated, the less overall transmission and the better protection for everyone. This is very important."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com