Keeping Schools Open: Whatever Happened to School Vaccination Clinics?*

Getting COVID-19 shots into the arms of children has now emerged as a critical piece in the seemingly never-ending struggle to banish the virus from our midst. When it comes to that front in the public health war, one province leads the pack, Newfoundland and Labrador. Three-quarters (74.7 per cent) of that province’s children, ages 5 to 11, have already had their first shot, with Nova Scotia second at 61.4 per cent and the others trailing behind.

Barely one-half (52.9 per cent) of New Brunswick’s kids had been vaccinated when Maclean’s magazine reported on Newfoundland’s success in getting kids vaccinated. While our eastern-most Atlantic neighbour has always been more vaccine friendly, the single biggest reason is the critical role played by school-based immunization clinics. Provincial officials in NL estimate that some 40 per cent of those shots have been administered in schools, a far higher rate than in New Brunswick and other provinces and territories.

Schools have been closed to in-person learning in New Brunswick all of January and are scheduled to reopen January 31. With Omicron surging, closing K-12 schools was deemed critical as a so-called ‘circuit breaker,’ and – in large part – because of the low vaccination rates among young children. It also meant that schools were essentially out-of-bounds for vaccination-on-demand shots in the one place where 98,000 children and teens gather each day.

With schools closed, New Brunswick did manage to push the vaccine shot rate for children up marginally to some 54.5 per cent during the past two weeks of the school shutdown. If getting shots into children’s arms in now the name of the game, the needle is finally moving. Given the urgency of the situation, and the significant time and resources being spent on ‘health-proofing’ school facilities, it’s fair to suggest that NB Health and NB Education might have been better advised to plan and implement a more comprehensive in-school vaccination program. There’s no question that child vaccination rates would have been far higher and staff still unvaccinated been given a convenient opportunity to get fully vaxxed or boosted to further advance mass immunity.

Minister of Education Dominic Cardy is, as is well known, a man of action, especially when it comes to campaigning for vaccine mandates. A month ago, when Omicron first reared its ugly head, his first reaction was instinctive. Gazing forward into 2022, his fertile mind was drawn to, what else? but the prospects for “mandatory vaccinations” for children. Instead of bringing vaccinations to every school, he was fixated on making compliance a condition of attending school.  That makes common sense, of course, if your overarching goal is to address all manner of childhood diseases through school-access vaccine requirements.

Minister Cardy and his Comms officer, Flavio Nienow, produced a helpful briefing note on January 25, 2022 on the province’s education sector immunization approach and record. Students identified as at higher high-risk of exposure and education staff were the priority, starting in late March and early April 2021, focusing on the 4,500 staff in high schools province-wide.

School-based vaccination clinics were run, on a limited basis, from September to December 2021. According to the NB Education and Early Childhood Development Department, they were “private clinics run by pharmacies” in collaboration with the Department. Only 24 such clinics were actually held, a limited reach when one considers that K-12 education is delivered in 294 school sites across the province.

The Omicron surge caught everyone off-guard, so let’s try to be fair.  What is clear, however, is that back in November when shots for the 5 to 11 population were authorized, New Brunswick was slower off the mark and ruled out mass inoculation, on a voluntary basis, through the schools. “The low take-up” in the initial fall 2021 was the reason given by Minister Cardy. Maybe so, but the scale of the Omicron surge and the vulnerability of children should have triggered a reassessment of the fastest, most efficient way of getting first shots into children’s arms.

Minister Cardy and his Department seem to have been laser focused on taking advantage of the January school shutdown to produce a return-to-school safely plan that ticked all the boxes and went one-better than some other provinces. Provincial teachers’ union leadership, vocalized by NBTA co-president Connie Keating, were a major factor in shaping the whole approach. Masks for all teachers, hiring more supply teachers, restoring classroom bubbles, and installing HEPA filters topped the NBTA ask list. Pushing for school vaccine clinics did not figure prominently in those health-protection representations.

When Keating spoke out about teacher concerns over the health and safety of members returning to in-person teaching, Cardy reacted swiftly, on social media and CBC News, defending the Department’s plan, emphasizing the change-of-position on installing portable HEPA filter units. Calming the anxieties of, and reducing the risks to, in-school personnel weighed heavily in the balance and so did limiting the number of supply teachers needed to cover elementary and secondary school classes. Eventually, the Department produced a report favourable to installing portable units and some $3-million materialized to outfit the 60 schools currently without proper air circulation systems. To its credit, the Department also did a more thorough assessment of the relative effectiveness of the competing HEPA filter units.

            The old adage of ‘the carrot and the stick’ applies to the campaign to boost vaccination rates at all ages. Scaring people with horror stories about COVID-19 and its after-effects, including ’long-COVID’ worked in securing much higher vaccination rates than usual for prevention of the seasonal flu.  A minority of the populace, including a relatively small proportion of parents, will likely never accept the need for, or effectiveness, of the shots. It may be a mistake to focus on clamping down with mandates in an effort to stamp out the resistance.

            The Pandemic is full of unexpected twists and turns – and it tests the agility of health and education policy-makers as much as ordinary citizens like us. We have just been taught a lesson by Newfoundlanders and that message even made the news in central Canada. School-based clinics can work if the focus is on expanding the points of vaccine delivery, making it more easily accessible for kids and, incidentally, their parents and families. School-based clinics may soon be coming to your school community. Looks like Ontario will be next, following the pioneering work done in Newfoundland and Labrador.

*Adapted from Education Beat, Telegraph-Journal, January 28, 2022.

Whatever happened to delivering vaccinations to children through the public schools? Why did it fall out-of-favour when the practice was critical in immunization campaigns that stamped out common childhood diseases? Shouldn’t we be providing vaccination access in local communities, closest to where kids and staff spend their weekdays?

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The Pandemic and Schools: Can We Learn to Live with COVID?*

Any hope for a definite end to the protracted COVID-19 Pandemic is gradually disappearing. The latest Omicron surge looks unstoppable in Canada and, in province-after-province, rates of infection and transmission are setting new records. Some solace is provided when we seize upon signs of fewer serious cases requiring lengthy hospitalization and leading to death.

A fundamental psychological shift is underway with profound implications for children, families and schools. “When will the Pandemic end?” is giving way to “How can we learn to live with COVID?” Confronting a rampant Omicron spread, necessity is giving birth to a new line of thinking. Leading global thinktanks were the first to confront “the new normal” and it’s now being embraced by those once thought least likely to change their scripts, Canada’s provincial public health officers.

The shift from big- P “Pandemic” to little-e “endemic” was forecast by health science experts specializing in epidemic diseases and policy wizards commissioned to forecast social trends. A decade ago, medical researcher Sander L Gillman, produced a rather obscure book, Diseases and Diagnoses: the Second Age of Biology (2010), connecting the dots between “Moral Panics and pandemics” and forecasting a global “pandemic killer” potentially worse than the 2009 H1N1 influenza. Four months ago, the American public policy thinktank McKinsey & Company got out front of us by daring to produce a policy research paper with the rather audacious title “How the world can learn to live with COVID-19.”

The Big Shift on COVID-19 has now arrived and is seeping into public discourse. The latest episode of CBC-Radio’s The House (January 8, 2022), hosted by Chris Hall, provided a virtual clinic on the profound re-orientation now underway. The dramatic and uncontainable spread of Omicron in January of 2022 has prompted Nova Scotia’s Chief Medical Officer of Health Dr. Robert Strang and a growing group of health experts to change tbeir approach to COVID-19 – and to publicly acknowledge that the populace is going to have to get used to living with the virus. Nowhere is that shift more profound than in our strategy of protecting children and teens in and around K-12 schools.

Nova Scotia’s public health chief, nationally recognized for his ‘tough’ COVID-19 regulations from March 2020 to December 2021, has changed his tune. “We are going to have to…move away [from  eradication], and accept that the virus that causes COVID is going to be around with us,” Dr Strang stated on air. Our new goal, he claimed, should be to “manage” COVID-19 based upon “having good levels immunity from both vaccination and infection…[so] that we no longer have to have these wide restrictive measures and…this huge focus on trying to identify as many cases as possible.”

That’s a seismic shift and Dr. Strang is not alone in changing their whole approach. Ontario Premier Doug Ford announced that the goal now is to “slow the spread because it cannot be stopped.”  Dr. Strang’s opposite number in Newfoundland and Labrador Dr Janice Fitzgerald has also come to that conclusion. Health care policy expert Katherine Fierlbeck of Dalhousie University offered a succinct explanation for the change. People eventually “get tired of top-down governance,” she said on CBC’s The House, and to retain public trust requires more transparency, including fuller disclosure of the evidence used in making decisions, its limitations, and the tradeoffs between potential benefits and harms.

Convincing school-age parents and educators in our K-12 schools is proving to be a formidable late-pandemic challenge. Pandemics like COVID-19 tend to evoke and provoke extremes in people, clearly revealed in UBC psychologist Steven Taylor’s October 2019 book, The Psychology of Pandemics. While some people in the broader education community are resilient and cope fairly well with the uncertainties, a significant proportion of others, especially parents of younger school-age children and educators, reflect what Taylor terms the “cave syndrome.” Fearful of COVID-19 spread, they become “excessively anxious” spinning a protective web at home and resistant to sending their kids back to school until absolutely every potential hazard and germ has been removed from that environment.

Much of that hyper-vigilance is reflected in a new wave of child-protection parent advocacy. Examining the social media traffic produced by one such parent Facebook group, Nova Scotia Parents for Public Education, an online community of 22,700 parents and friendly educators, provides plenty of evidence of the mass psychology. That group, coordinated by Stacey Rudderham, and a small group of engaged parents, has led the charge in alerting parents to every potential “exposure site,” identifying all manner of lapses in school-level public health precautions, and signs of potential mass outbreaks.  Public spokespersons for the group  have even challenged the credibility of Dr. Andrew Lynk and his IWK Children’s Hospital team.

The N.S. Facebook group built its membership by creating an early warning system for school-level exposures and attracting hundreds of concerned parents. Over the past 22-months, Rudderham’s group has also supported the Nova Scotia Teachers Union, several times, in pushing for school closures as “circuit breakers.”  Organized pressure group activity, going back to March 2020, helps to explain why Nova Scotia, with comparatively low case counts until recently, has closed schools for a total of 21 weeks, second only to Ontario in North America.

Echoing NSTU president Paul Wozney in early January 2022, the Facebook group “deplored” plans to return to in-person schooling, calling into question the repeated assurances of Dr. Strang and public health officials. That strategy worked, because recently-elected N.S. Premier Tim Houston relented to the public pressure, extending the holiday break, for the second time, and into a third week.  In short, Dr. Strang’s CBC Radio The House comments was actually aimed at changing the channel in his home province.

Watch for the Big Shift underway in public health policy. When it arrives in your province, you can expect it to mimic the public policy “management” strategy mapped out by global think tanks. You can expect provincial leaders and public health officers to (1) define the new normal; (2) monitor progress through “disease surveillance”; (3) limit illness and death; and (4) slow transmission, responding to identified “hot spots.” 

It will not be easy to convince stressed out parents suffering advanced “COVID-fatigue” that the dreaded COVID is here to stay and we have to learn, somehow, how to cope with the changed landscape, both inside and outside of schools.  It will also take far more than a few media briefings and targeted comments drawing upon the McKinsey & Company playbook on how to “manage” our way from Pandemic to endemic.

*An earlier version appeared in The Hub.com

What are the profound psychological effects of the Pandemic – and does it qualify as a Moral Panic? If the Omicron surge is unstoppable and the virus is present everywhere, are schools (with proper supervision and layers of protection) the safest places for children and teens? Is it a matter of necessity being the source of invention?  Will provincial public health authorities succeed in calming heightened public fears and helping us to adjust to the changed epidemiological conditions?

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Chicken Little and Teens: What’s the Secret to Raising Resilient Adolescents?*

Everyone remembers the children’s fable about a chicken called “Chicken Little” or “Henny Penny” who believes that the sky is falling when an acorn falls on its head. While the phrase “the sky is falling” is now something of a cliché, it pops up, now and again, especially during pandemic times. Raising or working with today’s wired and hyperactive teens, it can seem, on certain days, that some psychological disaster is underway or right around the corner.

Searching for meaning, suspended between childhood and adulthood, experimenting with new relationships, and saturated by social media – that can thrust you into the so-called “New Age of Anxiety.” It’s also a situation that’s tailor made for a new book written by a New York City psychoanalyst like Dr. Erica Komisar, a family practice therapist who specializes in diagnosing and treating children and adolescents.

For Freudian psychoanalysts like Komisar, childhood and adolescent experiences do much to shape adult lives and lie at the root of later psychological distress and emotional disorders. In her case, she’s famous (or infamous) for cutting against the popular grain in her public comments and regular opinion columns, appearing mostly in the Wall Street Journal.

Two of Komisar’s recent commentaries stirred up a hornet’s nest because they challenge prevailing North American urban and secular values. She hit a nerve with parents by taking a definitive stand on two critical issues: spending time more time with children during motherhood and imparting comforting religious beliefs during adolescence. While rooted in Sigmund Freud’s classic theories of psychoanalysis, they are also dramatically out-of-sync with today’s the secular and materialist values dominating television, social media and North American popular culture.

For Komisar, giving voice to such views landed her on ABC’s “Good Morning America” and other high-profile mainstream television shows. It also turned the small l-liberal New Yorker into a virtual pariah shunned in liberal intellectual circles as a prophet of homespun, anti-feminist family values. Five years after the appearance of her first book Being There: Why Prioritizing Motherhood in the First Three Years Matters and two years after one of those Wall Street Journal columns went viral, she’s still holding her ground after weathering the media storm. Pretending to believe in God, essentially ‘lying to children,’ to provide troubled or lost teens with a sense of comfort is, at best, controversial advice that can be hard to shake in the public domain.

“Second Chances” was the proposed title for Komisar’s latest book tackling the formidable challenge of raising teens in the aptly termed “New Age of Anxiety.” When her sequel to Being There appeared in November 2021, it did so with the click bait title Chicken Little, the Sky isn’t Falling. That title is also a bit misleading. It’s actually more about giving parents a second chance to get it right, than about dispelling popular mythology that the sky is indeed falling in pandemic family times.

Komisar has very specific views about the “right” and “wrong” way to parent. Some of her positions, such as prioritizing personal relationships with your children and regulating the use of technology and social media, make common sense. A number of others rankle professional women and working mothers, simply because they promote a more family-friendly, child-centred approach to child rearing and guiding adolescent development.

If Facebook executive Sheryl Sandberg is the exemplar of “leaning in” to seize professional opportunities, Komisar is today’s best-known promoter of staying at home or devoting more time to motherhood in the early years.  “Working and nonworking mothers,’ she wrote in Being There, “should strive to be as present as possible during the first three years of their child’s life.”

Being a good mother, according to Komisar, comes with rather high expectations. Nurturing a sense of “attachment” is “an ongoing process throughout the first year” and one that requires “continuous split-second maintenance.” Furthermore, your child’s cognitive development, future mental health, and general well-being rides, to a considerable degree, on those early parent-child interactions. Reading her books, mothers who returned to work or entrusted their young children to day care programs can be forgiven for feeling that they may have fallen short in early parenting.

One American mother and blogger, Melissa Langsam Braunstein, saw Komisar’s first book as adding to the pressure felt by most moms. “I can’t remember the last time I read something that made me feel so judged,” she wrote in November 2017. “There’s an off-putting shock-and-awe aspect to the book’s tone, making you feel that whatever you’re doing as a parent, it’s not good enough.”

Komisar’s second offering, Chicken Little the Sky isn’t Falling, does not sugar-coat the “scary” aspect of parenting teenagers, but it does strike a more hopeful tone. While many parents regret not spending more time with their children in the early years, they do have a second chance to make it right during the period known as ‘long adolescence’ from age nine to 25.

The good news is you do get second chances when children reach adolescence. “We expect more of teens today than ever before, and yet give them less,” Komisar told me in a recent interview. “They grow up faster and faster and it’s accelerated by social media. That’s what makes it such a vulnerable time.” But it is “never too late” for parents to “improve or repair your relationship with your child.”

“Adolescence was always a time of stress – a tough time in child development – but it’s now a bigger test of resilience.”  Heaping on new expectations has “taken it away” to the point where teens are, in her words, “adultimorfied,” or treated like adults before they are fully ready for those responsibilities and pressures. Parents who recognize the changing nature of adolescence and make efforts to provide “a secure foundation of support, emotional security, and real and meaningful connections,” can make a difference in shaping their lives.

What the author provides is a fairly comprehensive, thoroughly researched and documented, guide chock-full of mostly sensible and practical advice covering the whole gamut of contemporary issues, including gender and sexual identity, anxiety and depression, disordered eating, ADHD, vaping, bullying/cyberbullying and social media addiction.

The author is at her best dispensing advice to parents and teens about identifying and alleviating mental health disorders and helping teens navigate academic and social pressures. Much of that stems from lessons learned through clinical practice in Manhattan and in raising her own three adolescent children. While the book was written before the pandemic, it does deal with family pressures, excessive social media usage, and increased home-bound, internet-enabled social isolation.

Komisar paid a price for taking a public stand on adolescent insecurity and the enduring value of believing in God.  “As a therapist, I’m always asked to explain why depression and anxiety are so common among children and adolescents,” she wrote in her widely-read Wall Street Journal op ed back in December 2019. “One of the most important explanations – and perhaps the most neglected—is declining interest in religion,” she added. “This cultural shift already has proved disastrous for millions of vulnerable young people.”

That piece, bearing a sensationalized title, “Don’t Believe in God? Lie to Your Children,” cause quite a furor, obscuring the real message.  Her central point, lost in the media storm, was, in fact, soundly based upon a 2018 Harvard T.H. Chan School of Public Health study which linked religious upbring with better health and well-being in early adulthood. Young people who attended weekly religious services or practiced daily prayer or meditation, the researchers found, experienced “greater life satisfaction and positivity in their 20s” – and were “less likely to subsequently have depression symptoms, smoke, use illicit drugs, or have a sexually transmitted infection – than those raised with less regular spiritual habits.”

Her latest book may have a catchy title but it’s unlikely to become a best seller.  Since the release of Being There, Komisar’s much more aware of what it takes to capture the mood of the mass reading public. It’s even harder when you take a moral stance in favour of prioritizing motherhood and defending religious values.  “You’re fighting social trends,” her closest confidante recently commented. One of her own teens struck a more hopeful tone. “Don’t worry, mom, you have influenced a stadium of babies.”

*Reprinted from Convivium, January 10, 2022.  

Why has Dr. Erica Komisar stirred up such a hornet’s nest among today’s parents?  How important is “mothering” in the first three years of a child’s life? Do parents get “second chances” when kids enter “long adolescence”?  Should we pretend to believe in God when teens reach out looking for purpose and direction?  All sensitive questions in Pandemic times.

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