One morning this week, Jeff Crane pulled into the parking lot of the public school where he has worked for more than eight years, but this time, he had to show identification to gain entry. He was not annoyed – rather, he was heartened.

As he arrived, hundreds of residents had joined a long, winding queue as it stretched along the sidewalk outside a vaccine pop-up clinic at Thorncliffe Park Public School, where Mr. Crane serves as principal.

The school is nestled in a community that endured some of the highest rates of COVID-19 through the worst of the pandemic. There were more than 80 cases among staff and students over this academic year, making it a hot spot within a hot spot.

Every shot in every arm made Mr. Crane feel as if another step had been taken toward a return to normalcy this fall.

“We did as much as we could to prevent spread here,” Mr. Crane said. Class sizes were capped at 20, portable air purifiers placed in classrooms, COVID-19 tests were accessible to the community, and there was more than enough personal protective equipment for staff and the kids. He paused. “Hopefully,” he added, “it will be better in the fall.”

As one of the most disrupted school years winds down, parents, educators and doctors are turning their attention to September. Will masks be necessary? Are extracurriculars returning? Should class bubbles continue? Children under 12 are not yet eligible to receive a vaccine, and doctors say that any return to “normal” will depend on factors such as adult vaccination uptake and the potential spread of the Delta variant, which could have an impact on in-class learning.

“We now have one year of experience and research under our belt. There’s absolutely no excuse now – we should be prepared,” said Saskatoon pediatrician Karen Leis, chair of the Canadian Pediatric Society’s Action Committee for Children and Teens.

Earlier this month, Quebec rolled out its back-to-school plan that included no masks or classroom bubbles if vaccination rates climb higher and the COVID-19 situation remains manageable. Similarly, British Columbia said this week that students there would be back full-time in the fall, no longer grouped by classroom cohorts. The use of masks in schools would be decided later in the summer, the B.C. government said.

In Ontario, the government has set aside money for ventilation improvements and learning recovery. However, parents, doctors and educators have called for more specifics, especially as the province has kept two million students learning from home since mid-April despite rapidly declining COVID-19 case numbers.

Dr. Leis said that ideally young people over the age of 12 would be vaccinated by the time school starts up again. However, recent reports of heart inflammation in young men after a second dose of mRNA vaccines, which are produced by Pfizer or Moderna, may add a wrinkle to those plans.

In places such as Perth, Australia, and Israel, a country that aggressively moved to vaccinate adults, children are no longer required to wear masks in schools. But in Britain, where the government recently dropped its requirement for secondary-school pupils to wear masks in classrooms, the highly transmissible Delta variant is affecting the young and unvaccinated.

Dr. Leis said that provincial governments and school boards may need to keep some of the existing health and safety measures in place “because we don’t have quite all the variables accounted for, and we will see how things are in the fall.”

In a recent study, researchers from the U.S. Centers for Disease Control and Prevention and the Georgia Department of Public Health found that COVID-19 incidence was 37 per cent lower in schools that required teachers and staff members to use masks, and 39 per cent lower in schools that improved ventilation. The researchers described them as “important strategies” that would help schools remain open.

In Canada, discussions have also centered on how to safely cohort students. After pushback from families, the Toronto District School Board said this week that it would abandon the quadmester model, where students take two classes at a time per quad. Instead, the board said it would put in place a modified semester where students take four courses at a time, but switching between two classes each week. Students would be in school full time, but the revised model would allow for an easier transition if they have to abruptly shift to remote learning.

Jeffrey Pernica, head of the pediatric infectious-disease division at Hamilton’s McMaster University, said that there is no reason schools should not look more normal for students in the fall, including the return to extracurricular activities.

He said that the requirement of masks will depend on how much of the virus is circulating in the community at the time. Screening of students for symptoms should continue, as should public-health contact tracing, he said. It is unclear if whole classes and siblings would be sent home if cases are reported, as was done this school year, especially if infection levels are low. Further, doctors agree that improvements to school ventilation systems would be beneficial over the longer term.

“I have not seen any data to date that has ever shown that schools in and of themselves amplify community transmission,” Dr. Pernica said, adding, “I feel very optimistic that children will be able to go back to school without worsening levels of circulating virus.”

Lynora Saxinger, an infectious-disease physician at the University of Alberta, concurred. “Schools have actually done a really good job in limiting transmission in the school setting,” she said. “There’s quite a lot of polarization and feelings run high in this area, but just objectively speaking, it’s been actually all right.”

It is clear that school-age children, as a group, tend to be less affected by COVID-19 than adults, but of greater concern is their role in spreading the virus and what that might look like when more adults are vaccinated.

Dr. Saxinger said that governments and educators should focus on hand hygiene, cohorting and improved ventilation for the new school year. On the flip side, the practice of quarantining library books and keeping students from bringing in materials can be abandoned, she said.

Amy Greer, an epidemiologist at the University of Guelph, said she wonders if other respiratory illnesses, such as influenza and respiratory syncytial virus (RSV), which have been barely detected this past year, will return in the fall. She said she’s cautiously optimistic for September, adding that masking and cohorting should be in place, at least initially.

“We’re still relatively lucky in that the majority of cases in young kids do appear to be mild. But we can’t take our eye off the ball here,” Dr. Greer said.

“I don’t think we’re going to be looking at school closures,” she added. “I don’t think we’re going to be looking at massive disruptions in the same way. Vaccine is going to really help us to buffer that risk significantly.”

The Globe and Mail, June 19, 2021