News Clip: A bus pulling in, students getting off, doing something this hour that no child in Canada has done four months and that is step into a classroom. Primary schools and daycares reopened in Quebec today, though only outside Montreal. Attendance is not mandatory and strict physical distancing rules are in place.
Jordan: As provinces across the country begin to open up, one of the questions on everyone’s mind, from epidemiologists to doctors, to working parents to teachers and even to the kids themselves, is what happens when schools open? If there’s one thing that we know about kids and COVID-19, it’s that we can’t really be sure of anything. See, kids are often super spreaders of disease. That doesn’t appear to be the case here, but we don’t really know for sure. Younger children are often hit hard by respiratory illnesses. But so far at least, not by this one, unless of course, you count the terrifying new reports of a syndrome associated with COVID that’s causing horrific symptoms and even death in some kids. So in other words, like with so much about this virus, we’re still learning. And in order to confirm what happens with COVID-19 in children, we need two things. First, we need large studies that gather enough data to make the picture clear, and alongside those, even though it’s risky, we need children in their natural environment, and that means school. What will happen when the kids go back like they did in Quebec this week? What will we learn? And how much longer could we keep them at home anyway before the damage that that does to them outweighs the risk? Today, we’ll get into everything that we know and don’t know about COVID-19 and kids. And we will do that as soon as Claire tells us all the things that we need to know today, including, and some of you will get mad at me for this, but I honestly don’t care, golf is coming back to Ontario. Oh yes. Claire, what’s going on?
Claire: Yes, golf in Ontario is in the news today, and I’ll get to that one, I promise. But across the country, post-secondary students can start applying on Friday to receive emergency benefits. This program was announced last month, and it will provide students up to $1,250 a month from May through August. That amount can go up to $2,000 for students who are caretakers or students with disabilities. Concerns are starting to be raised about lifting restrictions too soon, especially in Ontario and Quebec. Quebec has now relaxed some of its restrictions around sports, including tennis and golf. And Ontario is expected to announce a big one today, the reopening of golf courses. It’s not known if there’ll be opened in time for the May long weekend, but that announcement is expected to come today. And these come at the same time as words of caution from experts around the country, who say we could see big spikes in the number of cases of COVID-19 if we move too quickly with easing restrictions. And starting today in Manitoba, anyone who has any symptoms of COVID-19, even the most mildest symptom, can and is being encouraged to get tested for COVID-19. Residents no longer need a referral, but the province has set up an online assessment tool for anyone who may be wondering if they should get tested. As of Wednesday evening, 72,200 cases of COVID-19 in Canada with 5,389 deaths.
Jordan: I’m Jordan Heath Rawlings, and this is The Big Story. Kelly Grant is a national health reporter for The Globe and Mail. Hello, Kelly.
Jordan: Why don’t we start this conversation by you just telling me about Dr Kate Zinszer and who is she and why does she have such a personal stake in the story we’re talking about today?
Kelly: So Dr Zinszer’s an epidemiologist. She’s at the University of Montreal and she’s one of the co-leaders of a study that they’re trying to get off the ground in Quebec that they hope will tell them a bit more about how often kids actually transmit the Coronavirus. Now, as you said, she does have a really personal connection here, and that is that I think she sort of exemplifies the really hard decision that some families are having to make because we don’t really understand this question about transmission. Her husband has stage four cancer, he’s undergoing chemotherapy, which makes him sort of the classic immunocompromised person, and she has two kids and the older of those two, Charlie, who is six, has something called Apraxia, which is a motor disorder. It’s a neurological disorder that affects his speech. And he was really thriving in kindergarten and really doing very well. And now, of course, like everyone, they’ve had to take him out. And because she’s in Montreal, which is looking at reopening schools on May 25th she and her family have this choice to make. You know, how important is it to have Charlie in school, versus how important is it to protect his father from the possibility of the Coronavirus? And if we better understood how likely Charlie or kids like him were to transmit the virus, that might have an effect on her personal decision.
Jordan: So how do you go about finding that out? Cause I know, you know, even personally when we talk about sending my daughter back to daycare or other families that we know, you know, that’s the first thing we wonder about and we have never seen anything that really conclusively told us.
Kelly: Well that’s because nobody really knows. So what Dr Zinszer and her colleagues at use of Montreal, Laval, and sort of public health authorities at the provincial and local level in Quebec, are trying to do, is sort of follow a large group of children at what they would consider sentinel schools and they would try to do testing of these children and try to get a sense of how often they actually transmit the virus. Now, this particular study is still very much in the planning phase, and you know, right off the bat, one of the difficulties they are running up against is figuring out, you know, what’s the testing technology that you can use to follow these children? Because as everybody knows, there’s issues around testing capacity, and also some of the kinds of testing that you might want to do can be a bit tough on children like these very deep nasal swabs. So what they’re looking at doing is collecting samples of saliva or what are called dried blood spots, which is where, you know, you sort of prick your finger and put it. On a piece of paper, and then, you know, testing can be done through those dried blood spots. But they’re actually looking at trying to perhaps collect the samples before some of the technology is perfectly in place. So that question of how they collect and analyze the samples is a big one for them to start. But of course, there still will be the kind of regular PCR, which is a test for the active infection that will still be going on at the same time. So with any of the children they’re following are tested through the sort of regular means, they can follow them and then see, do these kids take this home and give it to their families? Do they spread it to other children? Do they spread it to teachers? So they want to try to follow this and figure it out.
Jordan: So we might not have seen anything conclusively, but I’ve definitely seen various conflicting reports. Can you kind of explain a little bit about what we may be think we might know about kids’ role in spreading this?
Kelly: I like how you said maybe think we might know cause that actually sums it up really nicely. So there have been some smaller studies done that seems to suggest not the children don’t transmit it, we clearly know that they do, some have, it’s happened for sure, but that perhaps they don’t play as big a role in community spread as older folks, as adults do. And so that comes from a couple of different places. There’s been some data out of Iceland, and data out of the Netherlands, a pretty interesting study out of Australia, and some looks at household clusters. And what all of these kind of small studies, all of which have various weaknesses or various caveats. But what they seem to have come to the conclusion of is it seems like they may spread it a little bit less than adults. And there’s a couple of different sort of theories about why that may be. One of them is that children do seem, for the most part, to be more mildly effected by COVID-19. So some of the thinking is just like, even though there is asymptomatic or presymptomatic spread going on, that you’re perhaps less likely to spread it to as many people if you’re not, you know, coughing wildly or sneezing wildly, right? But of course, you know, these studies are all imperfect. This stuff is hard to figure out. And one of the things right off the bat is, you know, a lot of these studies have taken place sort of in an environment where school wasn’t running as normal. The Australian study I mentioned, some of the data gathering happened while schools were technically still open, but after, um, the premier in that Australian state had encouraged people to keep their kids home. So, you know, we’re really going to get a good answer to this only after schools are up and running in a sort of widespread way.
Jordan: Yeah. And can we just pause for a moment to talk about how strange it is that there is now a disease out there that kids seem to spread less? Because I think anybody who has ever had a preschool age child knows that you get it from them. And it’s so strange to contemplate that this works the other way, or at least might.
Kelly: Well, that’s one of the many things about this virus that just, you know, it keeps on surprising people. And I’ve had, you know, plenty of doctors and other experts say to me that they have found this to be very humbling. Because yes, their assumptions at the beginning was that children, even if they didn’t get terribly sick, would be big in terms of driving the spread of the virus. And so far that doesn’t seem to be the case. It would be very different from what the situation is with things like influenza, you know, where there have been studies of sort of closed Hutterite communities where vaccinating just the children really drops the amount of influenza they see spreading in the communities. And this does seem to be different, but I should really like, I really do want to emphasize that these are early impressions. These are imperfect studies, and we really don’t know yet whether this is going to hold true at scale when schools reopen on mass.
Jordan: Do these studies, as imperfect as they are, seem to suggest that it could be safer than we think to open schools? Or are we still just rolling the dice because as you mentioned, you know, Montreal’s ready to go in like two weeks here and that seems really soon to me all of a sudden.
Kelly: Yeah. I mean, to a certain extent it is rolling the dice cause I don’t think we have definitive answers. But you know, there are ways, I guess to roll the dice that aren’t quite as risky. And if you look at how some European countries are reopening their schools, there are some that are doing sort of mass testing, that are putting in place very strict physical distancing rules, that are doing part time classrooms that, you know, there are ways perhaps to do this where it’s less of a risk. The other thing is that there are acknowledged big risks in having kids out of school. The reason why this is such a hard choice is because kids are hurt being out of school.
Jordan: Yeah well, you mentioned off the top kind of, with Dr. Zinszer’s child that, you know, he’s really doing well and all of a sudden has been pulled out in how do officials talk about trying to balance that? You know, the, the needs of children who are missing out on development versus the risk to their families by bringing them all together?
Kelly: Well, it does seem like there’s a pretty broad acknowledgement that this lack of schooling, lack of formal schooling, especially for elementary school aged kids, cannot go on forever. I mean, I just have not heard anybody talking about, in a serious way that schools are going to stay closed until there’s a vaccine. Everyone seems to sort of acknowledge that, like the things that kids lose by not socializing, by not receiving a formal education, children with special needs, children who live in poverty, schools all play a hugely important role in helping kids who are in those kinds of positions. So everyone seems to be sort of in agreement that at some point, some form of school has to resume for these kids.
Jordan: What steps has Quebec taken as they prepare to reopen, to try to mitigate this risk?
Kelly: So the first thing is, is that, as you mentioned, schools are not open in Montreal. On Monday, schools reopened in parts of Quebec outside of Montreal. And it does seem like different schools are taking slightly different approaches. But they’re doing things like capping the number of students in the classroom, keeping playground equipment closed, not doing things like gym and art and library, they’re trying, I guess, as much as possible to maintain the sort of two meter physical distancing that we all know, now know is a big part of our lives. They’re trying to do that within the schools.
Jordan: I saw what at least purported to be, and I didn’t investigate it, so I can’t say this in all seriousness, but a list of some of the things that the schools were doing and one was like conducting recess by having the children walk outside in an orderly line, maintaining distance from one another.
Kelly: I know, I know. I saw that go around on social media too, and I will admit, I haven’t done any serious reporting on that, but yeah, it did make it sound like minorly as those school was like a prison yard.
Jordan: Yes. On a more serious note, what other work is being done on COVID-19 and kids in Canada? Cause you’ve looked into a bunch of this stuff.
Kelly: Yeah. So there are a couple of really interesting studies that are ongoing, but that haven’t really produced much data yet. So I’d sort of divide them into two categories. One is studies around transmission, right? So the one we’re talking about in Quebec, which is not yet off the ground, but they’re trying to get the protocols in place. And then there was another study that doctors at Sick Kids and St Mike’s hospital in Toronto are running. It’s part of a long running project on childhood development called Target Kids. And what they’ve done is sort of create a separate study within that group for COVID-19. And what this sort of new covert related offshoot is doing is having parents and children within the existing study start doing weekly COVID-19 testing plus track, you know what their symptoms are like, and track how they’re handling the isolation. So hopefully that study, which is has been ongoing for a couple of weeks, hopefully that will start producing some data related to COVID-19 spreads soon. And there are studies that are looking at the question of how the virus actually affects kids. How does it make them sick? And how often does it make them sick? And there’s a big international study going on that a professor at the University of Calgary is running. That’s taking a look at sort of internationally, what are the kinds of outcomes kids have when they get the virus? And then the Canadian paediatric surveillance project, which is another sort of very long standing study, is also gathering data about how COBIT is affecting kids in Canada, from 2,800 paediatricians across the country. And they’re weekly sort of sharing their data with this kind of central gathering system, and they expect reports and preliminary results in a couple of weeks.
Jordan: What do we know, at this time at least, about how kids are impacted by this? I think, you know, the broad understanding is that they handle it better than adults. But is there anything that confirms that? Like how has that been developing? Because as you said, we seem to learn more as we go down this path.
Kelly: Yeah. So I think that big picture is still true, that on the whole kids tend to catch this last and get serious symptoms of it less. Their illnesses do tend to be mild. There are a couple of exceptions, that are a little bit scary, but I think we have to keep them in perspective. So one is that children who had serious underlying conditions, that they tend to not do as well. There was just another study that came out this week looking at a bunch of cases in the US of which children had died with COVID-19, and a lot of them had sort of very serious underlying health problems, the kind of thing that might, you know, have you on a feeding tube or that sort of thing. Then there is this, what they’re calling sort of paediatric multi-organ inflammatory syndrome. This is this kind of mysterious new illness you might have heard about. First sort of was reported in the UK and now it’s been reported in New York and in several other European countries. And what this is, is this is children who are otherwise healthy coming into hospital with something that looks like a combination of an inflammatory blood vessel disease called Kawasaki disease and toxic shock syndrome, sort of really marked by very low blood pressure. These children also seem to have gastrointestinal symptoms, like quite upset stomachs and vomiting and diarrhea. And some of the children who have presented with this kind of mysterious syndrome in the UK and the States and other places, some children have died. Some have been in the ICU and on ventilators. Some have tested positive for COVID-19 and others have not. And the very early thinking is that this may perhaps be the sort of immune system going into overdrive after the infection has been cleared from the body. But this is all something doctors are really trying to learn about now. It’s all very new and there’s a lot that’s unknown about this right now.
Jordan: Do we have an idea of the kind of scale or prevalence of that? Because obviously as you say, it sounds really scary.
Kelly: So it does seem to be extremely rare right now. And as you might’ve noticed, the places that I mentioned where this has been seen is places where they have a lot of cases. So part of the reason it seems that it hasn’t turned up till now, is that it’s so rare that it seems you need to have, you know, a sort of mass of children infected before you’ll turn up one of these cases. So in Canada, there was a group of children at the Sainte-Justine hospital in Montreal, a larger number than normal that came in with this sort of Kawasaki like presentation. And doctors there are trying to figure out whether that group of children may have suffered this mysterious syndrome. None of those children died. One went to the ICU but is okay. And none of them tested positive for an active COVID-19 infection. But the hospital is now doing serological testing, which means they’re looking for antibodies that might indicate that the children had the coronavirus in the past.
Jordan: Do we have a timeline on– and I realize again that, you know, we’re always finding out what we don’t know, but a timeline on when we should have some at least semi conclusive data on how children spread it? Because, you know, one of the first questions that comes to mind is kids want to see their grandparents and their aunts and uncles, and, you know, it’s a pressing concern for a lot of people.
Kelly: Yeah, totally. I mean, it’s a pressing concern for me. I’m sure it is for you, it is for lots of families. So I would say like big picture at the population level, we should have a decent idea later this summer as we watch and see what has happened with the reopenings in Europe in particular. I mean, there are some things that even if you’re not doing a study, it’s hard to hide that if you send children back to school and all of a sudden hospitalization spike in case numbers spike. So we should have at least some better sense, I think by the end of the summer when we really watch what’s happened in Europe. It won’t be as straightforward as being able to say, you know what, it’s safe for your three-year-old to see her grandparents. Because what we’ll get is sort of a population level picture. You know, are they more or less likely to spread? But we won’t be able to know for certain if your child can’t spread, and I think that probably the across the board recommendation will remain that as much as possible, people who are old and vulnerable because of other health conditions should probably stay in isolation as much as possible, as hard as that is to hear and to bear.
Jordan: Well, it’s nice to know at least what we know and what we don’t know. So thank you, Kelly.
Kelly: Thank you.
Jordan: Kelly Grant, national health reporter at The Globe and Mail. That was The Big Story. If you need more, you can find us at thebigstorypodcast.ca. You can find us on Twitter at @thebigstoryFPN. And you can write to us or send us a video or send us a voice memo by emailing firstname.lastname@example.org. You can also find us in your favourite podcast player. There are dozens of them and we are in all of them. If you can leave us a rating, leave us a review. Let us know what you think. I’m Jordan Heath Rawlings. Thanks for listening. We’ll talk tomorrow.
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