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Archive for the ‘Flu Season Outbreaks’ Category

The global footprint of coronavirus – COVID-19 – is expanding and national governments as well as regional school districts are making the difficult decision to shutdown the schools. On March 11, 2020, the World Health Organization officially declared it a “pandemic” and all of Canada’s education ministers participated in a teleconference to discuss the situation and potential policy responses, specifically following the annual March break for students and teachers.

Political leaders at the highest levels, working closely with public health authorities, are weighing their emergency measures options to combat the pandemic, ranging from school closures to mass quarantines. Closing schools may be politically expedient, but its effectiveness in curbing transmission is far from clear.

School closures have already interrupted the public education of some 300 million students across the globe. The first nation to close schools was Hong Kong, back in January, then Japan on February 27, and now many more jurisdictions have followed suit, including Italy, South Korea, Iran, France, Pakistan, New Delhi, the New York City region and northern Washington State.

Deciding to close schools in the case of COVID-19 is particularly challenging for one major reason. In the initial wave, the novel coronavirus, unlike HIN1 in 2009, had not affected children at high rates. Out of 44,672 initial confirmed cases in China, fewer than 2 per cent occurred in children under 19 years of age, and no deaths were recorded among those younger than 10 years old. That may be a low estimate because the attack rate for children, at a later stage in Shenzhen, was 13 per cent.

Closing schools, in some previous epidemics, has proven helpful in reducing transmission of seasonal flu among children. One 2013 British Medical Journal report, based upon a systematic review of epidemiological studies, concluded that school closures contained rates of transmission, even in the absence of other intentions. Yet determining “the optimal school closure strategy” remained “unclear” because of the wide variation in its forms of implementation.

Tracking the impact of school closures has proven tricky for researchers.  Some closures were limited to individual schools and, in other cases, whole school systems. Closing before the peak of the outbreak or well into the outbreak suggests that decisions are being made as either a precaution or a reaction to rising student influenza-related absenteeism. In some cases, schools close so children can receive antiviral medicines or vaccines, or in conjunction with a strategy of “social distancing.”  Such wide variations in implementation strategies makes it a challenge in determining which change actually affected transmission.

The body of research on school closure impacts during epidemics is surprisingly large, encompassing the 1918 Spanish flu epidemic, the 2002-03 SARS pandemic, and the 2009 HINI flu outbreak.

Yet the results of those school closures have been mixed. Closing schools for more than two weeks has been linked to lower transmission rates in Hong Kong (seasonal and pandemic flus) and in England (H1N1), but not so in Peru (pandemic) or the United States (during seasonal flu epidemics).

The 2008 Hong Kong outbreak, the 1957 epidemic experience of France, and the 1918 pandemic records in some U.S. cities demonstrate that shutting schools can have no discernible impact, especially if decisions come too late in the cycle of the outbreak. Relying upon older parents or grandparents to be caregivers during closures may actually increase mortality rates among more susceptible populations.

Public heath experts caution educational leaders and school principals against basing decisions on the North American H1N1 experience. “The sensitivity of the 2009 pandemic to school closures probably relates to the high attack rates in children compared with adults,” the BMJ study pointed out. “Outbreaks in which children are less affected” such as COVID-19, “might be less sensitive to school closure.”

Closing schools also has broader socio-economic impacts and unrecognized health effects. There are trade-offs in being overly cautious by closing schools, including potential lengthy disruptions in student learning and compelling parents to stay home from work. Students from lower socio-economic neighbourhoods would also be deprived of school meal programs and cost-free supervised athletics activities.

The most authoritative study of school closure impacts, in the August 2009 issue of The Lancet, actually assesses broader community impacts. If all U.K. schools closed, some 30 per cent of health and social care workers would be taken out of commission, compounding adverse effects on the financial health and viability of communities.

School authorities would be well-advised to consider the potential duration of closures in their emergency response plans.  While it is probably wise to err on the side of caution with school-age children, the longer the closure lasts, the more problematic it becomes, especially in the absence of e-learning bridge programs.

Closing schools for more than two weeks to combat COVID-19, as in the case of Hong Kong, could have a detrimental effect upon the school schedule, year-end-examinations, and the conventional grade- promotion system. It’s possible, perhaps likely, that students will be seriously set back by missing so much instructional time.

Implementing “e-learning plans,” including digital and distance learning, is recommended by the U.S. Center for Disease Control and Prevention (CDC), but there’s a major problem with that constructive proposal in its guide for school administrators. It’s feasible in e-learning ready school systems like those in Hong Kong, United Arab Emirates, and the State of Ohio, but not yet in our provincial school systems.

Few Canadian school districts are prepared or trained to implement e-learning days system-wide, and they have, with few exceptions, resisted piloting e-leaning modules during winter season storm days.  Scrambling to implement hastily prepared distance learning or online courses will not prove effective at all. Nor are schools fully equipped to administer year-end assessments online or to report the results electronically to students and parents.

Closing schools may be expedient in assuring the concerned public that actions are being taken to control the spread of the contagion. This is especially so now that managing the fears and anxieties of children and families is emerging as a priority during the COVID-19 pandemic.

Given the lower attack rates for children and the weight of research evidence, it’s much harder to make the call to dismiss classes and suspend school for what may well be an indeterminate period of time.

 Should schools be closed to contain and reduce the transmission of the 2019-20 coronavirus?  What does past experience closing schools during epidemics tell us?  Should schools be closed early in the cycle as a precaution or in reaction to escalating attack rates among children and their teachers? How prepared are school districts to implement e-learning as a bridge in the teaching-learning process?  If schools do close, the question is — for how long given the unpredictability of the spreading contagion?  

*An earlier version of this commentary appeared in The National Post, March 11, 2020. 

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Students are now coming down with seasonal colds and the flu.  What was predicted to be a normal flu season in schools turned ou out to be highly unpredictable with the arrival of a ghost menace – the fear of coronavirus, now labelled COVID-19.  Public anxieties were fed by a popular media inundated with frightening stories about the spectre of coronavirus, rivaling that associated with the outbreak of SARS in 2002-2003. The latest scare also sparked a disturbing undercurrent of suspicion, with racist undertones, directed at Canadians of Chinese ancestry.

The common flu remains a bigger threat than coronavirus but you would never know it from the media coverage.  Some 25,854 confirmed cases of the regular flu have been reported since late August 2019, and, so far, the coronavirus, has only infected a dozen Canadians. Some 12,200 Canadians are hospitalized for influenza each year and about 1,000 die across Canada. In 2002-2003, for comparison purposes, 44 people died of SARS in Canada.

Normally calm Public Health authorities are now forecasting an uptick in cases throughout February into March. Teachers and principals will be on the front lines because schools are well-known breeding grounds for germs and infections.

This flu season it is going to be worse because, according to the Public Health Agency of Canada (PHAC), the country is seeing an unusually high number of Influenza B cases, which tend to cause more severe illness in children. Of the 33,615 reported Canadian influenza cases (up until February 8, 2020), 11,905 were classified as Type B, with 57 per cent of those patients under 20 years-of-age. Reported Influenza B cases were also more common in the Maritime provinces of Nova Scotia and New Brunswick.

Face masks are disappearing from pharmacy shelves as people are either wearing them outside or hoarding them in the event of a global pandemic. Nova Scotia’s Chief Medical Officer of Health Robert Strang claims that the masks are not guaranteed to offer protection and may encourage people to touch their faces, actually spreading the germs.

The global outbreak is Chinese in origin and that most regrettably still carries insidious connotations. It may have originated in Wuhan in China’s Hubei Province, where some 57 million citizens were placed in a state of lockdown and isolation, but exaggerated fears and anxieties have spread worldwide. The two-week ordeal of international tourists trapped on the quarantined and virus-ravaged Diamond Princess cruise ship anchored in Yokohama, Japan, further fed public anxieties.

Combating and surviving the flu season in school used to be so much easier. Counselling students and teachers to stay home, drink fluids, and get rest used to suffice in weathering the seasonal onslaught. Most of us fooled ourselves into thinking that miracle cures for the cold and flu like Cold-FX were actually working and toughed it out with Tylenol, Hall’s cough drops, and, on a bad day, toilet tissue kleenex.

Today’s principals, teachers, and students come to school prepared with new weapons in the ongoing war against contagion. Wiping down desks with disinfectants and packing little bottles of Purex in pockets and purses is now standard practice. A few even don surgical masks to keep colds in, or ward them off, walking to and from school.

Fear and panic are running high in Ontario and British Columbia school districts where many of the students are Chinese Canadians or recent arrivals of Chinese descent. Vocal and active parents are clamouring for schools to increase screening of Chinese students suspected of being carriers and sending home children whose families have recently returned from China.

Coronavirus-induced tensions are most acute in York Region, north of Toronto, particularly in Richmond Hill and Markham, where 40 per cent of the population is of Chinese origin. A coronavirus-inspired petition targeting Chinese families launched in late January in York Region, north of Toronto, was quickly endorsed by parents in 145 local schools and generated some 10,000 signatures. In the York Region District Board of Education, Board Chair Juanita Nathan and Education Director Louise Sirisko, were compelled to send out a memorandum to all schools in direct response to the level of concern and anxiety being felt by families of Chinese heritage.

While the province of Nova Scotia is home to some 3,500 Chinese-born students, the only public display of concern was by Max Chen, a second-year Chinese student at Cape Breton University. After searching in vain for surgical masks to send home, he voiced his concern that the province’s public health officials were unprepared to deal with a potential outbreak at the university.

Public health officials, educators and academics are fearful of schools and universities becoming swept-up in an us-versus-them cycle of racism directed at those who look different. Spreading of misinformation and ignoring facts from public health agencies is symptomatic of deeper, sublimated problems.

A leading SARS impact researcher, York University’s Harris Ali, who studied the stigmatization of the Chinese population in Canada, put it best. Gaslighting the Chinese as carriers of the contagion, he claims “feeds into already pre-existing underlying biases or prejudices.”

Global pandemics turn flu season into a mass psychological experience that can overshadow the actual health risks of transmission. Calming and dispelling exaggerated fears as well as sanitizing desks have now become the essential skills in a 21st-century educator’s repertoire. That may be a clear indicator of the high anxiety temper of our times.

Why was the current flu season so unpredictable in our schools?  Were Canadian public health authorities ready for the surge in Influenza B, the strain most commonly infecting young people of school age?  Are principals and teachers fully prepare to deal with students showing signs of coronavirus?  What are the challenges posed by containing the spread of viruses while ensuring that students and families of Chinese ancestry are not unfairly targeted in the broader community? 

*An earlier version of this commentary was published in The Chronicle Herald, February 15, 2020.

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