Toronto East School Support - Q&A Compilation
A new forum created by East Toronto Family Practice Network (EasT-FPN) and Michael Garron Hospital (MGH) for our local schools to ask questions on how they can implement the health guidelines while operating schools during the pandemic. This includes practical COVID-19 information, supportive networks for our schools and the opportunity for a Questions & Answers with Dr. Janine McCready, Associate Director, Infection Prevention and Control, specialist at Michael Garron Hospital.
Who is it for?
Principals of local East Toronto public schools.
How it works:
A virtual video/teleconference on a regular basis. There will be updates by Dr. Janine McCready, as well as other health and non-health speakers providing relevant information and/or resources.
A Q&A session with Dr. Janine McCready will follow the updates. Please submit your questions in advance of each session.
This forum is by invite only so if this is pertinent and of interest to you, contact us to receive a calendar invite that will be updated with materials in advance.
Within the forum participants receive:
COVID-19 Overview and updates
Information on available EasT-FPN and MGH support
Knowledge sharing from family practices in the East
Q&A with Dr. Janine McCready, Infectious Disease Specialist, Associate Director, Infection Prevention and Control (IPAC), Michael Garron Hospital.
For more information please see Toronto Public Health Website Information on COVID-19 School Information for Parents and Caregivers
Summary Documents
Missed a forum or would like to refer to a specific session? Take a look at our summary documents for more information below:
The notes and compilation of Q+A will be from the sessions with Dr. Janine McCready. This is not clinical advice but rather a summary based on discussions at the Toronto East School (TESS) forum. For additional clarity, please call in to the forum, contact Public Health or your family physician school liaison.
Content Discussed - Last updated Jan 11, 2021
I. HAND HYGIENE V. SYMPTOM MANAGEMENT
II. MASK WEAR VI. STAFF PROTOCOLS
III. CLEANLINESS VII. MISCELLANEOUS
Hand Hygiene
Q: How often should hands be cleaned at school?
A: As soon as students enter classroom, after bathroom, before and after eating, anytime students touch mask, before and after snacks. Hands should ideally be cleaned with soap and water for 30 seconds or an alcohol based hand sanitizer (minimum 60%, if no soap and water available). Witch Hazel, Apple Cider Vinegar and other products are not recommended at this time.
Mask Wear
Q: If students have masks on, do they still need to be 6 feet apart?
A: Even with masks on, we want to keep our distance and avoid crowding as much as possible. There is a study showing the risk of transmission with/without wearing masks for short and long period of times in less and more crowded areas inside and outside. See attached BMJ graph with spectrum of masks, physical distancing, ventilation and occupancy showing risk of COVID increasing.
Q: Do staff and students need to wear masks outside while playing?
A: Mask breaks are important. Dr. McCready recommends not forcing children to wear masks outside. However, a strategy to store masks is important and maintaining physical distancing as much as possible.
Q: What are best practices for mask storage for the students? How can teachers help?
A: Dr. McCready recommends hand washing before and after handling masks. Ask students to fold their mask in half so the insides surfaces are touching each other and the outside is visible, preferably with a large name label. Masks can be put in large paper/clear bags or the student’s own individual fanny packs/ pouches.
Q: How do we minimize students constantly touching or fiddling with masks, especially those with sensory difficulties?
A: Proper fit will reduce mask touching. The mask should snuggly cover mouth and nose. Adding an extra elastic band to secure across the back of the head in addition to ear loops can be helpful. There are some extenders like the back of a ball cap that can lie across the back of the head so that the mask is attached to the extender and not rubbing on ears.
Q: Can lanyards help with mask storage and tracking?
A: Dr. McCready advises they can be helpful if there is a quick release mechanism in case the lanyard catches on anything during play. However, there are alternative storage methods that are more cost effective.
Q: Are there any concerns of using masks for long periods during higher temperatures? Does mask wearing lower oxygen levels?
A: There are no overlying concerns for using masks during higher temperatures. They can be uncomfortable to wear for long periods during high temperatures or in poorly ventilated rooms. In these situations Dr. McCready recommends ensuring proper fit and incorporating more mask breaks i.e more time outdoors. Cloth ear loop masks do not lower oxygen levels.
Q: Is there a benefit for younger students (JK-SK) wearing masks, even if its improperly? Is it true that masks are only good for 15 minutes and they lose effectiveness after that period?
A: Wearing masks improperly do not demonstrate a benefit. However, a properly worn mask even for short periods can be beneficial. Mask wearing for these ages can also be practiced at home to improve proper wear and endurance. The mask provides benefit while it is being worn properly no matter what the length of time.
Q: What are your recommendations for mask wear during gym class? Can students take them off as there is more space to physical distance?
A: Continue wearing mask during indoor play for increased consistency. It is hard to control how the students interact with each other while engaged in physical play such as gym class.
Q: What is the best way to approach a student not wearing a mask?
A: Dr. McCready recommends finding the root cause, why is the child not wearing a mask? If this is a resource issue, the EasT-FPN network may be able to assist in guiding and perhaps making resources available. If the child is simply unable to wear a mask for developmental reasons or family preference, unfortunately this cannot be helped. Nonetheless, she states that the more children wear masks the more beneficial it is in limiting exposure!
Q: Any tips on making the face shields more comfortable?
A: Ensure the head strap fits well and is not too tight as they have caused some discomfort
Q: Can students wear a gator in place of a mask?
A: Gators are not the best form of facial covering to limit transmission, non medical cloth facial masks are the better option.
Cleanliness
Q: How often do materials need to be cleaned?
A: Depends on age of child. Younger children require cleaning between all students ideally. And for older students ideally between cohorts
Q: Electronics - how often to clean?
A: Suggest cleaning with alcohol wipe on high touch surfaces
Q: Music Instruments - Should students wear gloves and sanitize equipment?
A: NO gloves. They allow for false sense of security. Avoid sharing toys between children. They need to be sanitized throughout day, and ideally between use. Minimize amount of things shared between students and especially between cohorts.
Q: For singings and instruments - What requires ventilation or how long to wait before changing classrooms?
A: Currently no singing and woodwind instruments allowed. Therefore children are allowed to change classrooms without waiting.
Q: Sharing books in Library? Can students take a turn reading the same copy of a book (during guided reading for example) if they use sanitizer before handling the book and after they are done with the book?
A: Transmission on objects plays a smaller role than droplet spread. Using hand sanitizer before and after is helpful as well as encouraging then to keep their hands away from their face. However, when dealing with kindergarten children that touch hands and mouth- better to leave things aside for 72 hours between use if you can.
Q: How do we properly disinfect face shields for staff?
A: Dr. McCready states typically storing in a well ventilated space is sufficient, if further cleaning is required she advises to use alcohol wipes or Lysol wipes and hang to dry.
Physical Distancing
Q: For eating - how far apart to kids need to be?
A: Once masks are off, protection is gone. Ideally need to maintain physical distancing. Suggest eating in larger areas or outdoors. Stagger lunches, send home kids for lunch. Outdoors - increased space but even with less space, risk of transmission is less if they can ensure hand washing before and after eating.
Q: Sharing the playground - What should be enforced?
A: Outdoor recess, allow different classes in different areas of playground which leads to less transmission between cohorts. So if one case, less likely of transmission between classes. Suggestion is to keep cohorts separated outdoors - extend outdoor space to nearby greenspace. Maintain some distance, but impossible to enforce.
Q: How should washrooms be separated?
A: Divide based on classroom location and isolate. Wear masks when kids go to the bathroom. Encourage hand washing.
Q: How important is physical distancing for the students while outside?
A: Although transmission is less likely outdoors, it is still a good idea to promote some sense of physical distancing. Dr.McCready has seen creative methods integrated into play such “zombie arms”. She recommends to ensure students are not congregating in small huddles to play something like Beyblades or cards.
Q: Can we use barrier methods such as plexi-glass dividers during lunch time?
A: The reliability of barrier methods is very subjective and need to be reviewed on individual basis. The safest method for limiting exposure during lunch time is to maximize physical space between students and only have masks off while eating. Students can still enjoy the rest of their lunch time in a social manner with their masks on.
Q: What is an ideal class size for limiting exposure?
A: Class size is not as important as the space per student ratio, larger spaces allow for better physical distancing thus limiting exposure.
Q: Can we add the use of a fan in addition to open windows to increase ventilation within the classroom?
A: Dr.McCready does not recommend the use of a fan as it can spread the virus droplets further than it can travel normally.
Symptom Management
Q: What is protocol when a student/staff sneezes or coughs?
A: Everyone sneezes once in a while. Initially more challenging and nerve racking. Hope is to empower schools to make these decisions. If cough/sneeze once - no need to do anything. If persistent cough/sneeze or new/worsening - then needs investigation. Child needs to go home. Seasonal allergies or pre-existing conditions should be individually evaluated.
Q: Would mobile onsite testing be available for staff and students?
A: Dr. McCready has reached out to TPH, TDSB trustees to get parental consent to send out mobile testing to test children onsite. But this requires pre-consent from parents to test children. If TDSB and principals can facilitate, this would be helpful.
Q: Assessment Centres - Will more be open once school starts?
A: Assessment centre located at Michael Garron Hospital is currently open. In 2nd week of school - Sept 21 - a clinic will open in Thorncliffe Park for 10-14 days and depending on hotspots, pop up clinics would open in those areas.
Q: If a student displays symptoms of COVID-19, is it also necessary to send their sibling, who has no symptoms, home?
A: Yes, as per current guidelines all household contacts of a symptomatic person should be sent home.
Q: What is the best protocol for recommending COVID-19 testing for students?
A: Dr.McCready suggests only recommending students to get tested if they are symptomatic and/or have had close exposure to a positive case of COVID-19, ideally they would get tested 5-7 days post exposure.
Q: Are runny noses still used as a symptom for screening purposes for COVID-19?
A: Although other parts of Canada are not using runny nose as a symptom, Ontario is still using this as a standard screening symptom as many children who have acquired COVID-19 have had this as their main or only symptom.
Q: Does a student who has either tested positive for COVID-19 or has a household member positive for COVID-19 require a negative COVID 19 test before returning to school?
A: Currently the best practice is to ensure the student has isolated for 14 days from onset of symptoms/ confirmation of test within household and be asymptomatic before they return to school.
Staff Protocols
Q: Staff are required to wear masks and face shields, however the face shields fog up on cold days outdoors. Can they be reserved for inside use only?
A: Dr. McCready advises, face shields are not necessary outdoors so long as appropriate physical distancing can be maintained. If physical distancing cannot be maintained please continue to use proper protective equipment for both teachers and students.
Q: What are best practices for educators who move between multiple schools? Should they only work at one school?
A: Ideally, minimal movement across multiple locations is preferred, however this is not always possible. Dr. McCready suggests that if an outbreak occurs at one of the educator’s locations to ask them to not travel between multiple locations until it is controlled; this is what was practiced within the Long-Term Care homes and has reduced exposure between the homes.
Miscellaneous
Q: Any suggestions on how to empower staff to come back to work?
A: Staff are extremely anxious, and it’s an important question without an easy answer. Lessons learned from the first Wave of COVID. It takes time. To help alleviate fears, clear communication and transparency. Daily broadcasts, ability to ask and answer questions, provided forum to express concerns. We know more now, PPE effect, physical distancing works, masks work. Sharing other jurisdictions that have opened successfully with restrictions in place have not seen wide outbreaks. Prepare staff with how to manage when a case does occur - like a “COVID drill”. This will be a work in progress - it will take weeks for people to feel comfortable.
Q: Should teachers be washing work clothes immediately and should shoes be left at school?
A: No need unless there is very close contact with a sick child. If it alleviates anxiety - Yes.
Q: How quickly do classrooms in schools shutdown?
A: Today Ontario Ministry of Health released guidelines on when a classroom would shutdown. What should happen - more information about the initial case. Entire classroom should go home and isolate if exposed to a real case. Siblings and external school contacts should be managed by TPH. Siblings of a case with COVID should isolate for 14 days. If siblings are positive, their class should go home and isolate for 14 days.
See here on Guidance of School Outbreak Management provided by the Ministry of Health.
Things to think about:
Minimize mixing of kids in school - so try to combine kids in club, daycare, bus, etc to reduce exposure risk.
Preparation - get children to wear masks, teach them how to wear and practice. Teach them how to wash hands properly.
Principals - have non- medical masks available at school for kids for those that forget.
Q: How can teachers assist in reducing mask fatigue and mask irritation?
A: Incorporate mask breaks into daily schedule and letting students know when they will occur. This can help their endurance and minimize overall irritation. Ensuring proper fit can help with general irritation- and some creativity such as an elastic band or head band to take pressure of off ears.
Q: Can long term physical distancing and mask wearing negatively impact the student’s social development i.e learning to share & play in groups
A: Dr. McCready isn’t a child psychologist/ psychiatrist and does worry about this as a parent. However, she highlights that many educators are finding creative solutions to physical distancing limitations in the classroom to supplement lesson plans. Helping kids understand by explaining why we must physically distance can help kids understand these new measures.
VIII. TRANSMISSION
Q: What is the incubation period for COVID-19?
If I was in contact with a person who tested positive on day 1 and I take the test on day 4, will the result be accurate? How many days do I need to wait to take the test so that results are accurate? I have been told by a doctor that there is a 30% probability of getting a false negative. Please do explain this.
A: The incubation period is 14 days- this is the time it takes for someone to show symptoms of the virus. If a person has been exposed to another person with COVID-19, it usually takes 5 days for the symptoms to appear but can take up to 14 days before you show signs of infection. Because of this, you should not get tested too early after exposure to someone with COVID 19. You should self-isolate until the full 14 days have passed. If you test negative on day 5 of exposure to someone with COVID you still have approximately 30-40% chance of developing symptoms and having COVID-19.
Q: What is the transmission period for COVID-19?
If a person gets the virus, are there periods when the person is infectious or noninfectious?
A: This is called the communicability period- the time you can shed enough virus to give it to someone else. Current research informs us that you are shedding enough virus up to 5 days prior to symptom onset and 10 days after symptom onset. This means, that for contact tracing it should start from 5 days before symptoms showed up or, if a person has no symptoms 5 days before the positive test date. People with COVID 19, need to remain at home until at least 10 days after their symptoms started, and get directions for their particular case under the guidance of their health care provider, or Public Health.
Q: How is it determined what amount of exposure to a covid positive student is considered unsafe? Should we be minimizing the transitioning of students through the hallways?
A: Current guidance is looking at exposure when neither person is wearing a face mask or PPE. Exposure is considered higher risk if you have spent a total of 15 minutes time within 6 feet with neither person wearing a mask.