Nerissa Crichlow of Toronto has a lot of unanswered questions about what school will look like for her twin daughters in September.
"First and foremost, are they going to be splitting up the classes? What is that going to look like? Are there going to be testing measures in place?"
She describes herself as "very concerned" about the risk of her seven-year-old daughters, Mila and Norah, contracting and bringing home the coronavirus if in-person classes resume in the fall.
"I really need a good understanding of what the protocols are going to be. I'm asthmatic, my daughter is asthmatic, my father is asthmatic, and my mother has lung issues," she said.
"For me, it's really important that the schools have some testing involved, because we are all susceptible to the virus, more so than others."
Crichlow has plenty of company among Canadian parents who have questions about the looming school year, but the latest research shows young children are at low risk of getting or spreading the coronavirus that causes COVID-19, and that missing school can have long-term costs for a child's well-being.
Dr. Nisha Thampi understands parents' reticence about the return to class. The medical director of infection prevention and control at Children's Hospital of Eastern Ontario in Ottawa is both a pediatric infectious disease physician and a mother.
She said she's been encouraged, though, by recent study results that give more insight into children's risk of contracting the illness and of spreading it to others.
"It is with more information around the risk of transmission and infection that we can inform the policies for school setting and other community settings," said Thampi.
A large study from South Korea, published by the Centers for Disease Control and Prevention in the U.S., found that children nine and under infected others in their households just 5.6 per cent of the time, while children 10 to 19 spread the virus at the same rate as adults, nearly 19 per cent of the time.
And research continues to show that illness is usually mild in children.
A recent meta-analysis of 550 COVID-19 cases among children under 18 in China, Italy and Spain found just nine children had a severe case. One, who died, had underlying conditions.
Parents must be 'partners in care' to prevent spread
"There's good data that shows in the majority of cases, a child with COVID-19 has a symptomatic adult in the home who is also COVID positive," said Thampi.
That means some of the power for controlling the spread of illness within schools hinges on parents acting as "partners in care," teaching their kids about good hand hygiene and making sound decisions about their own physical distancing practices, she said.
While it made good sense to shut down schools at the beginning of the pandemic when we were just learning about COVID-19, we now have an opportunity to learn from other parts of the world that have reopened schools with new safety protocols in place, she said.
"I support families who are concerned about schools not being a safe place to return to, because I would suggest that a pre-pandemic school environment did not have the strategies in place to minimize infection spread," she said.
One issue, she said, was that many parents faced work pressures that made it difficult to keep sick children at home.
Working from home isn't possible for all jobs, but the pandemic has shown it is an option for many working parents. That, combined with a new vigilance around respiratory symptoms, may help establish new standards for keeping sick kids home from school.
"I think we will be returning to a school setting so long as the right policies are in place — a school setting that is safer in terms of infection transmission risks and that offers opportunities for learning, socialization and, importantly, peer-to-peer learning and development," Thampi said.
That could mean measures such as spreading kids apart from one another in smaller groups, training children on hygiene practices in school and doing some learning outdoors when weather permits, she said.
Now that children have been without the structure of school for many months, it's become apparent that eliminating all risk of school-based transmission comes at a cost, said Thampi.
Getting kids back to class between waves
That's a point Dr. Michael Silverman, chair/chief of infectious diseases at London Health Sciences Centre and St. Joseph's Health Care London in London, Ont., wants to make clear.
"So many times I hear, 'Well, you can't be too careful,' without recognizing the risks of being home," he said.
The research that's not getting enough attention these days are the studies on the repercussions of students being out of class, he said.
"If they miss school, there's long-term impact on their cognitive development, on their social development and their overall ability to function in society."
Of course, all children will be at a similar disadvantage because of school closures, but the impacts will still be there, he said.
A study from UNICEF Canada found that the COVID-19 pandemic is having an unprecedented impact on the lives of children and youth, citing disrupted routines and loss of education and other resources. The organization is calling on governments to "deliver new crisis mitigation measures" because children "cannot wait months or years to return to school."
Given that children under 10 pose little risk of infection transmission to others, it makes sense to return their cohort to class, said Silverman.
"If they're the least likely to get sick, they're the least likely to transmit, and they do worse with distance learning, the priority should be at least the very young children should be able to get back to school," he said.
As September approaches, teacher unions are asking for clear plans for safely reopening schools. The Ontario English Catholic Teachers Association, for example, has called on the provincial government to give direction to school boards about their responsibilities to ensure the safety of students and staff.
Silverman points out that most infectious disease experts anticipate a second wave of the illness will come.
"If we don't take advantage of the time when we're at a relatively low level of transmission, when another high level of transmission comes ... and then we close the schools again, there will be an extremely long period of time with no education."
Silverman said he believes the choice should remain with parents as to whether their kids learn in the classroom — with best practices for infection-control in place — or from home.
"What I'm advocating is that we should not close all schools and take away all parents' choice. That parents should be able to make educated choices on behalf of their children as to what they feel is best for their family."