Jordan: It’s fair to say that for the sake of kids and the sake of their working parents and the economy in general, schools need to be open. But it’s also fair to say that a lot of people from parents to kids, to teachers, to principals and doctors are going to be pretty anxious over the next few weeks as students return. And as we start to see COVID-19 in classrooms, because it is impossible to keep the virus out completely. And anxious people have questions and yes, there are a lot of guidelines out there for how to safely bring kids back to school. But every single school is different, and not all schools can follow those guidelines exactly. So those questions need to be answered and quickly. A new program started in Toronto’s East End aims to match teachers and administrators with doctors and hospital staff who can give them advice and give them answers that are specific to their situation, answers to things that aren’t covered in the guidelines. So what are those questions? What are teachers asking as their kids returned to class? What can be done when physical distancing inside seems impossible. What can be done when kids balk at wearing masks? When hundreds of kids need to enter a small school with only two doors and almost no outdoor space? Those are the things they’re asking and we’ll get those answers today. We’ll also get a report from the front lines of a hospital as cases rise in Ontario.
I’m Jordan Heath-Rawlings. This is The Big Story. Dr. Janine McCready is an infectious disease physician at Michael Garron Hospital in Toronto, where she leads the program we’re discussing today. Hello, Dr. McCready.
Jordan: The first question I have for you, because I ask it anytime we talked to somebody working in a hospital right now, is how are you guys doing? How’s morale there, how’s your ER, and et cetera.
Janine: I think we’re doing pretty well right now. I mean, we’re a very hardworking and resilient bunch here at Michael Garron. I think in the last couple of weeks, and especially this week, it has been, a little bit alarming and concerning to see the numbers rising faster than any of us would have liked. And so we’re really starting to put some of the plans back in place to ramp things back up for the fall, to make sure that we stay ahead of the numbers. But we’re overall, you know, everyone’s working hard and doing their best here.
Jordan: We’re now, in some places in Toronto, anyway, in the second week of back to school. And, from your point of view, as somebody who’s probably watching this very closely, how has it gone? How do you feel about the plan?
Janine: I mean, I have mixed feelings, I think. On one hand, I’m still cautiously optimistic that if we can turn things around with the community numbers and keep them low and really implement a lot of the prevention strategies that we know will work to open school safely, that we can do that and we can keep the numbers low. But on the other hand, we have started to see numbers kind of across many of the provinces outside of Atlantic Canada starting to rise. And we know that, as those numbers rise in the community, we will see COVID cases in school. So it will be more challenging to prevent the spread of COVID within schools. So I think, in Alberta, for example, they started a bit ahead, and here in Ontario, in some places, we’ve certainly seen some cases introduced, but few outbreaks, which is very encouraging, but I think we definitely need to stay on top of it and there’s going to be a learning curve for everyone because this is definitely new. And we have to recognize there’ll be some disruptions to school and to class, but I’d like to continue to be cautiously optimistic. And I think that the real, it’ll be a big test with TDSB going in this week, the biggest, one of the bigger boards, to see how that goes.
Jordan: When you say we’re kind of learning as we go here, how much of this is uncharted territory? Because in many places in Canada, except I think Quebec, schools went out for March break and never came back. So what are we going to be finding out over the next coming days and weeks?
Janine: So good question. I mean, we do know a lot from other jurisdictions of what worked. And I mean, I think a lot of the things that worked in places like Denmark and Norway, places that had low rates, is that low community transmission will prevent school outbreaks. And also this package of all the infection control strategies that we know work in other places, like physical distancing, wearing masks, screening to prevent people coming in. We know those things can work, but I think actually implementing them on a school level, in a realistic way, is where I think a lot of the learning needs to happen. I mean, Sick Kids just released some of their preliminary findings from a simulation they did in schools here in Toronto. And I think that that is helpful, but it was just a few day simulation. And I think that’s a good starting point, but really we’re going to have to see how each school adapts and how each at each individual environment is a bit different, and then how we can make iterative improvements. So even if we’re seeing, hopefully not COVID right away, but you know, some sniffles and things like rhinovirus, or other back to school coughs and colds, that we’ll be able to find that right away and then make changes to prevent other spread within the classes. So, I think just knowing that the big picture, the things that we need to do are fairly clear. But how do we actually make that happen on each individual school basis?
Jordan: Well how are you planning to do that? Because here’s why we wanted to talk to you. And this program that you’re a part of involves a lot of direct communication with schools. So what are you seeing or hearing, I guess, from teachers and administrators about what they don’t have or are worried about?
Janine: Yeah. Great question. I mean, I think there there’s a big variety in how teachers feel and certainly how the principals feel. And they’re getting a lot of advice from different sources and from their boards, which is great, but I think what we’re being able to do and help is that we’re able to try to translate that guidance that they’re receiving and really put the knowledge that we have from living and breathing COVID for the last six to eight months and help to really adapt that information to the local situation. So, for example, things like our school has two entrances and we have 800 kids that go in and out and we have limited outdoor space and there’s 3000 people with parents and siblings and everyone that come to our backyard to drop off kids in the morning and the afternoon. Like how do we actually screen everyone and get them in? And so that kind of school with everyone living in high rise buildings surrounding it, the approach is going to be obviously very different to entry and dismissal, than a school where everyone lives in a single family dwelling and there’s a big area in the back school yard where you can easily spread places out. So I think that they have a lot of support in terms of the guidance and what they know they need to do, but then how do you actually put that into action? So we’re hearing a lot of that. I think because this is new, going back for most teachers, there is a lot of anxiety and I think that’s totally reasonable and expected, and we’re able to so kind of share our experience of how we kept healthcare workers in the hospital safe and share that so that they feel supported. They don’t feel alone. And I think it means, it’s different coming from someone independent that’s kind of lived through the first wave in the hospital, as compared to coming from your employer, for example, where, it’s not that they should trust me more, but it’s just a different perspective. And I think for some people, it helps to be able to pose questions directly to someone like me or a primary care physician that they’re working with, to get kind of a different or more fulsome answer to some of their questions.
Jordan: So tell me exactly how the program works and what it does then.
Janine: Great. So, I mean, there’s a few different components to it that we’ve tried to provide support for the schools. So the first thing that we started doing was virtual town halls with some principals and teachers and the school support staff within the hospital’s catchment area. So back in about mid-August, we reached out, first to kind of higher priority schools. The schools that we had identified that, in the first wave, we saw higher incidences of COVID-19 and places that would be higher risks for spread within the community. So places that have lower socioeconomic status, families that are multigenerational. So if you have a kid that had COVID, they’d be more likely to bring it home and spread it to grandparents, aunts and uncles. More of a spread, versus if you’re in a kind of a single family dwelling, that’s obviously, you don’t want anyone to get it, but the risk of spread broadly is lower. So we started with the priority schools one week and then the next week actually extended to all the schools within our catchment area. And allowed them to basically just send in or ask questions on the live, virtual meeting and I answered them. And then we also had just some kind of, I reviewed some literature to support them and kind of larger concepts, just to kind of give them some overall information. So that was the first thing we started doing. And then in addition to that, we’ve created kind of a hub and spoke model that we are kind of buddying the family physicians and then community health centres to the higher priority schools within our area. So we have about 15 schools that we’ve identified that are a bit different than the schools that TDSB has declared as high priority and that they’ve given different class sizes to, and we’ve linked them with a family physician so that the principal or the vice principal has kind of a direct person that they can pose questions to. And then that person obviously can link up with me and my team so we can actually provide more support as things go. And then the third part is really to support testing. So we have an onsite assessment centre here at Michael Garron, which has been running since March, but then we’ve off-and-on, we’ve had some pop-up sites where we’ve seen higher needs of the community. So we plan two open two pop-up sites in local neighbourhoods that are more higher priority areas in school communities. So one right, actually this week, it’s going to be open for about two, starting with two weeks to see what the need is. And then another, in another higher risk area a little bit later on. So bringing the testing to the communities, and then with this we’re obviously working with the schools and with Toronto Public Health to identify if there are schools where we’re seeing cases, then we can work with them to provide mobile testing if needed, as well. So those are the kind of the three main things. And then I’m building a team here as well that we’re able to, in collaboration with Toronto Public Health, be able to provide more support to schools. If we are identifying that they’re having more issues and that they need more onsite support as well.
Jordan: You gave me a great example earlier of how you would kind of support a school that had only two entrances and exits and a ton of people needing to get in and out. Stories like that, that give real world examples of situations that the doctors are worried about are really helpful. Can you offer another example or two of things that teachers or administrators have asked you about like, how do I do this on the ground?
Janine: Yeah, for sure. I mean, I think a big one is mask wearing. So, it’s very dependent on the class, the age of the kids you’re teaching, and the developmental level of those kids. So teachers have questions about, well, how am I going to get the kids to wear the masks? What about mask breaks? How often do we, should we plan to do a mask break? How do I do a mask break? Can we do a mask breaks in the class? Do we have to go outside? And then just the logistical issue of, well, when the kid takes their mask off, where do they need to put it? Can they hold it in their hand, set it down, wear it on their wrists, people are making lanyards or there’s fanny packs. And there’s, you know, what do we actually do in a real life situation? And when kids go outside, can they take those off? When they go outside for gym class, can they take them off? And then just even, what are the things that we need to focus on in terms of wearing our mask properly? So, we all know there’s the very formal video of how to put your mask on and off and what health care workers follow, but when you’re dealing with a five-year-old, we’ve got to focus on the priorities and what’s realistic. So I think there’s been a lot of questions around that. Because the teachers also don’t want to feel like they’re kind of the personal protective equipment police all day, right? They want to be able to make sure the kids are safe, but also at some point, hopefully be able to focus on what they’re really good at, which is teaching all of our kids. So that’s been a big area and then, things like interpreting physical distancing. So we’ve all heard, you know, two metres is the ideal distance apart. But if that’s not possible, then is one metre useless or what does that mean? And so we’ve talked about how it’s really a gradient where the more space you can have then that does, it provides additional protection. And thinking about creative ways to set up the classroom so that you can add more space. So if you have twins in a class, you can actually set them together. They don’t need to be separated because they’re going to spend their whole life together. And then you can, that will provide you with extra room in the class to separate other kids a little bit further. So, and thinking about cohorting kids like that. So if you have, siblings or people that you know are spending time together outside of school, then those kids can be cohorted together within the class.
Jordan: On a personal note, actually, since you mentioned it, how do you get a toddler to wear a mask?
Janine: So I actually have a toddler, a three-year-old and so I was concerned or didn’t know how this was going to go, but she’s actually fantastic at wearing a mask. And I think the biggest thing that I realized was making sure that it fit properly. So we tried a few different masks before we found one that worked and then with, I mean, to be very practical , the ear loops, I find with some of the little ones, sometimes they’re fine, but other times they fiddle with them and they don’t fit right or it bothers their ears. So I just attached an old pair of nylons I cut up into strips and stretched it out a bit and just attach that over the back of the ear loop so it kind of sits at the top of her head, just on top of her ponytail, it doesn’t slide down and once she’s got it on, she doesn’t even notice it. And it’s actually, once we discovered that, obviously not every kid is the same and she’s the daughter of an infectious disease doctor, so she knows why masks are important. But I think that the fit is important. And then also just the practice. I think once kids are used to wearing it and are playing and doing different things while they’re wearing them. They often will actually forget about it. Not every kid, obviously, and some of them are going to be bothered. But I think that, as we’ve heard throughout, we can’t let perfect be the enemy of good. So if we can get most kids to wear them properly, then if there’s some issues, we don’t want to give up on the majority of people being able to wear them successfully.
Jordan: See, as the father of a three year old, who absolutely refuses, I appreciate the tips. This is the kind of one-on-one stuff people need.
Jordan: You kind of touched on it at the very beginning of this chat, but I also, while I have you here wanted to ask you a little bit about the hospital itself. And you mentioned, and we’ve all seen, anybody watching the numbers in Ontario has seen cases a creep up quite quickly, over the last couple weeks. What sort of things go into action at Michael Garron when you start seeing that, and as you mentioned, people start getting a little concerned?
Janine: Yeah, for sure. So, I mean, we talk a lot about kind of risk levels. So depending on what the levels of community transmission are and the percent positivity for testing and what we’re seeing, we’ll adjust our policies in the hospital. So how many people get screened when they come in? All of our isolation procedures are routine and we always do them, but really providing reminders that, numbers are going up, you have to increase your vigilance. We have a lot of ways where we kind of implement redundancies so that we’re less likely to miss any cases of COVID coming in, like daily or twice daily symptom checks for patients. And, so a lot of those protocols just deciding, okay, we need to be on higher alert, right? And letting staff know that things are ramping up and we need to change things, making sure that we’re aware of where the beds are available and that, if we get a surge of patients, where do we shift staff and how do we do that? And I think another important part, which is important for schools, for hospitals, for everywhere is just being vigilant about symptoms and infections in patients, but also in staff, because I mean, we saw in the first wave, there was a lot of cases of infections in staff, especially in longterm care. And then some of those people inadvertently brought those into nursing homes before we had universal masking and passed it on. So reminding staff that even if you have mild symptoms, you really have to go get tested and you can’t come to work and you know, we’re all human, so over the summer, I think people took a little bit of a breather, started to open up their social networks a little bit more, and people are used to socializing a bit more freely. So really making sure that everyone is wearing their mask when they’re in the building, unless they’re eating. And if they’re eating they’re, maintaining physical distance and that’s going to be important for schools, too. So just making sure we’re not lapsing into any bad habits. Also I think, as we’ve said, the communication with staff, so making sure everyone knows where we’re at and where we’re going. And then other small things like improving our turnaround time for swabbing for staff. So if staff are off or they’re sick, or they have sick kids, that we can make sure we are testing them efficiently so that we have enough staff, and that people are encouraged to go get testing if they do have symptoms. Because we do expect, you know, it was more, in the first wave, it was a bit easier because most people were at home. So they were having very minimal exposures outside of work. But with everything still being open, there’s a lot more people being exposed and their kids going back to school. So we’re really aware that we’re going to have to be more vigilant in that regard this time and prepare for the possibility that more staff are gonna have more community infections, not from the hospital, but from, from other interactions outside. So those are just a few of the things that are on our mind on a daily basis.
Jordan: That’s a good segue into my last question, which is, I think that everybody would probably agree that having schools open is really important both for the kids’ sake and for childcare. But as we start to see cases in schools, is there a point at which you would really start to get worried that outbreaks were happening and there’s a threshold where we need to talk about closing individual schools? Or what will you be watching for in schools as they reopen?
Janine: Yeah, I mean, that’s a great question. And I don’t have a specific threshold where I think, I think it’s going to be probably a moving target. And my biggest hope is I think we really, everyone, the government, all of us has to prioritize schools. And so if that means we do have to pull back not opening other things or closing other businesses, then we may need to do that in order to help keep schools safe. And I’ve explained to some people, because I think some people think that going back to school means, okay, there’s no more social bubbles. It doesn’t matter anymore because my kids are going to be exposed to everyone. And I almost think it’s the opposite. You have so much social capital to spend, and we’re using that all up at schools. So now we need everybody to be kind of twice as careful outside of school. So you’re only seeing people within your small bubble of your family within that six feet and without masks and that we really need everyone to be on board with that. I mean, in terms of what I’m going to be watching for schools? I think it will probably be very regional. I think that the same approach won’t be, it may not even be across the city, let alone across the province or the country, but I’d be watching…the main thing I’ll be watching is not just for cases in schools, but for transmission in the school. Because we know that there will be cases introduced into schools, but as long as we find them and the prevention strategies are working, then that’s good news. It’s when we start to see outbreaks, which would be two or more cases that are linked to each other, so one person spreads to another person within the school, that’s when then it’s going to start to worry us. So we will see some of those, but if we’re starting to see that in numerous schools or in numerous classes within the same school, then that’s when I think we need to reevaluate and see, okay, can we improve the prevention strategies? And if we can’t improve the prevention strategies and we can’t reduce the community transmission numbers because they are continuing to rise, then we’re going to have to have a really hard look at what’s the balance here. What’s the safest thing to do?
Jordan: Well, in the meantime, we will keep listening to you guys and keep our fingers crossed that it really doesn’t come to that. Thank you very much, Dr. McCready.
Janine: Thank you very much.
Jordan: Dr. Janine McCready, infectious disease physician at Michael Garron Hospital. That was The Big Story. You know where the rest of them are. They’re at thebigstorypodcast.ca. They’re also in your favourite podcast player. Apple or Google or Stitcher or Spotify, you pick. Go there, leave us a rating. Leave us a review. If you want to talk to us, find us on Twitter @thebigstoryFPN or email us. The address is firstname.lastname@example.org. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.
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