Jordan Heath-Rawlings: Here’s what I’ve been doing lately. I know I’m not alone. I have been trying to get a four year old really excited and eager for her first day of school while simultaneously holding back my own terror and anger and confusion. In about three weeks, probably, hopefully, kids across the country will head back into classrooms, mostly in person. At this time last year, parents were afraid, confused, nervous, had a million questions, that was all understandable. This time, though, I’m not sure it is. What do we know now about COVID and kids and schools that we didn’t know last year? How have we used that knowledge to make schools safer? How haven’t we? What is the real risk from this virus to kids under twelve this fall? Is the health care system prepared for a wave of serious COVID in younger kids? How long will it be until we finally see vaccines approved for this group? And did it have to be this way this fall? Because it feels to me like it did not. But maybe I’m missing something.
Jordan Heath-Rawlings: I’m Jordan Heath-Rawlings, this is The Big Story. Dr. Katharine Smart is the President of the Canadian Medical Association. She is also, pertinent to our discussion today, a pediatrician. Hello, Dr. Smart.
Dr. Katharine Smart: Good morning.
Jordan Heath-Rawlings: School is like three weeks away. I’m worried. How worried are you?
Dr. Katharine Smart: Well, I’m honestly quite concerned for the kids across our country as they look at going back into school with cases of Delta surging and vaccination rates plateauing. We have obviously many children in this country under twelve who haven’t yet been able to be vaccinated against COVID. And I think bringing them back together in school without the right safety measures in place really does put them at risk.
Jordan Heath-Rawlings: We’re going to get into what those safety measures could be and where we could do better. But first, maybe just from your position as a pediatrician and as somebody who’s been watching this, what do we know now about kids and COVID that maybe we didn’t understand quite so well at this time last year?
Dr. Katharine Smart: That’s a great question. You know, I think as COVID started taking hold around the world, naturally, everyone was very concerned about what this meant for their kids. Unfortunately, the rate or incidence of severe COVID and children remains very low, which is encouraging. However, what we have to remember is it’s not zero. And as the number of kids potentially becoming infected with COVID increases, as we’re seeing in the United States, the risk of more children having severe outcomes, needing to be hospitalized or requiring intensive care, could increase. And that is a scary proposition for parents.
The other thing we’ve learned is there’s other things that happen with COVID beyond the acute illness. There’s the risk of the multi system inflammatory syndrome that affects about one a 1,000 children who have COVID. And there’s also the risk of long COVID. And we’ve seen various numbers about that, sort of most people think it’s probably somewhere between 2 and 5% of children can have long COVID, so that’s a concern.
And then I think it’s also important to remember the impact COVID has had on children beyond just the disease itself. We have an epidemic of mental health crises across this country directly related to COVID and how it’s impacted children in youth. The lockdowns, the quarantining, not being able to go to school, watching their parents and grandparents becoming ill. The fear and anxiety around living through a global pandemic has had a massive toll on kids, and their mental health has at an all time low. So there’s those impacts as well.
Jordan Heath-Rawlings: What about the Delta variant specifically? Do we know anything in terms of whether or not it really is more infectious among children or leads to worse outcomes? Are we still waiting to kind of get a handle on that?
Dr. Katharine Smart: We definitely know it’s more infectious. There’s no question is that at least twice as infectious as the original strain of COVID, which makes it able to spread much more rapidly amongst people and particularly amongst people where vaccination rates are low. So that’s the concern that we have around young children that have not yet been vaccinated, who will be coming back together in congregate settings like schools. So that’s certainly a worry.
In terms of whether or not it causes more severe disease, that is still a bit unclear. Some preliminary data suggest perhaps the rate of being hospitalized with the Delta variant amongst children is slightly higher than with the original strain of COVID, but we don’t have a lot of great data on that quite yet.
Jordan Heath-Rawlings: I know that school board plans are up to individual school boards or mandates are up to the provinces, so I’m not going to ask you to speak to every school board or province across the country, but maybe as you’ve been looking at back to school plans from various places in Canada, in general, what do you think about them and what do they get right and what do they get wrong?
Dr. Katharine Smart: I think it’s been confusing for parents because as you’ve alluded to, we’re seeing different approaches across the country, and that can be confusing. I think in my view, where people are getting it right is proceeding into these next few months with caution. The Delta variant has just started spreading across Canada. We’re already seeing the beginnings of a fourth wave and number surging in various provinces, and that worries I think all of us as kids head back to school. So I think we need to keep that in mind and be cautious. When I’m looking at schools and school boards that are looking at things like mandatory masking, I think that’s the right step in areas that are are experiencing the Delta variant until we know more about what it’s going to look like in those communities. Kids are used to wearing masks. Most of them, I would say don’t really find it to be too big of a deal. So over the next few months, while we’re sort of sorting out where this is headed in Canada, I think simple measures like that makes sense. Also, schools that are looking at things like keeping children cohorted together, trying to increase opportunities to be outside, which we know is safer, and have focused on ensuring good ventilation in the classrooms, those are all the right direction.
The other positive step I’ve seen coming from a lot of teachers is a call for mandatory vaccination for teachers. We know that adults being vaccinated is one of the best way to keep children safe. And ensuring that educators have had their vaccines, I think, is another potential positive step.
Jordan Heath-Rawlings: What about the stuff that we could be doing but we aren’t in a lot of places? Is there still, and I know this is maybe a difficult question, but is there still any low hanging fruit, you know, that we could pick that would give us a better chance to keep cases low, keep schools open? What are our options?
Dr. Katharine Smart: I think a lot of school boards are struggling with the responsibility for these decisions being put on to them. I think a lot of places are wanting to see more leadership from governments in terms of setting things like mask mandates. When things are controversial, and you have people that don’t want to comply with things, when they have no choice, there’s a mandate, then more people are willing to be cooperative and just do what they need need to do. When those things start going away, you start to see more aggression, more acting out, more challenges to get people to comply with things that are now being recommended as opposed to demanded. And I think that’s a challenge for schools going into the fall here, is what does that look like for them? And I think it’s a source of stress. So to me, the low hanging fruit, I think, really is for our public health officials and our governments to still take the lead on making some of these decisions, which aren’t popular with certain segments of our society, but I think overall are understood by the vast majority of people, to make it easier for folks to have these things in place to keep students safe. There’s no real reinventing the wheel here. We know what the tools are. They are vaccinations. So we need things in place to encourage that last 10, 15% of Canadians to get vaccinated. And some of those things are encouraging people, reminding people, making it easy for people. Those are great.
But I think what we’ve also realized is just encouragement alone isn’t enough. We’re starting to see things like mandates, things like vaccine certificates as sort of a push towards people to say, look, you’ve really got to start thinking about more than just yourself here. The evidence is clear. These vaccines are safe. They’re effective, and you really need to have a medical reason not to be vaccinated at this point. So I think things like that are critical and need to evolve more over time. And then the public health mitigation strategies like we’ve talked about, we know they work. There’s lots of evidence that kids wearing masks in school, prevent transmission. We know keeping groups smaller, limiting who you’re in contact with, trying to be outside as much as possible. These are things we’ve done already for a year. We know they’re effective. So let’s keep those things going.
Jordan Heath-Rawlings: I’m glad you mentioned how well vaccines work, because as a parent myself, and as somebody who talks to a lot of parents, the biggest question I would say that we all have beyond the minutia of what back to school will look like in various mitigation strategies is when will we be able to get our under twelve kids vaccinated? What are you hearing about that?
Dr. Katharine Smart: Well, we know that there are studies underway, and we’re expecting that data to be available likely in September or October, so soon, I think is the answer. Now, of course, that would then need to go through approvals of Health Canada. But I think if the data comes out positive for children in that age, which I expect it will, I think there’s going to be a lot of pressure from the public and parents saying, okay, we’re familiar with these vaccines. We’ve been using them now for several months. Let’s get this going for our kids. And that’s I think, again, another reason why we should exercise caution here over these coming months is a vaccine for younger children is really just around the corner. So I don’t think any of us, as parents, want to be taking risks, unnecessary risks right now when we know we’re really only likely weeks or months away from our younger children being able to be protected.
Jordan Heath-Rawlings: That’s really good to know. And it kind of leads me to another question which touches on what you mentioned earlier about mental health and kids. If these vaccines are so close and we are in the middle of a wave right now, do we need to send kids back to school in person? Should we be doing this? I’m speaking personally here as somebody who doesn’t really have another option for child care, but to send my child to school. But I think there are a lot of parents who want to know if this is really the best call, if better days are just a little wait away.
Dr. Katharine Smart: I think schools are critically important for children, for their mental health, their socialization, and also for families. As you said, it’s been a big issue for parents not being able to have their children in school in terms of their ability to go to work and do the things that they need to do to keep their family moving forward. So there’s lots of reasons that schools are really, really important. And I think schools can be safe. I don’t think parents need to feel like it’s an either/or situation. What we need is the things we’ve been talking about in place to keep those environments safe for children. So I would hope that our governments, our leaders see that and realize if they put the resources where they need to be, they make some of these hard calls, like mandating vaccines. I think that we can get to a place where kids can be in school and be safe, which is, in my view, of the best interest for children and their families.
Jordan Heath-Rawlings: Do you expect this to be a topic of conversation the first couple of weeks of school, as coincidentally, we will be in the last couple of weeks of a federal election campaign? Like, I’m just imagining we’re already seeing cases climb pretty steadily here in Ontario, if they keep climbing and schools reopen and kids are getting sick. I would imagine this would be a hot button issue.
Dr. Katharine Smart: Absolutely. And I think we’re already seeing it as an issue in the election, especially around vaccine mandates and vaccine certificates. We’re already seeing the different parties come up with different perspectives on that. And I’m glad that’s being talked about, because I think those are critical tools to move us ahead in this pandemic. So, yes, I think absolutely. We’re going to be hearing more about this and what happens over the next weeks and months are going to be critical issues for politicians. You know, I don’t think that people have a lot of tolerance for decisions that impact their children in a negative way. And as a society, we value our kids. We want them safe and thriving, and we need to see our politicians prioritizing that as well.
Jordan Heath-Rawlings: Let me ask you about what happens if this doesn’t go well. There was a lot of discussion last year in all of the waves about not having enough beds and not having enough hospital capacity. Are we equipped as a health care system for a large number of sick kids who require very specific care?
Dr. Katharine Smart: I would say we are not equipped for that. Critical care for children is available really only at children’s hospitals in Canada, which are few and far between when you look at how vast our population is, and we have also limited resources to move children to those centres, when you’re living like we’re I do in the Yukon, and you need to potentially medivac a child down to the children’s hospital in Vancouver that can sometimes take over 24 hours to make that happen. And that’s just my situation, right. There’s many pediatricians working in rural and remote areas that face those same barriers when trying to move kids to higher levels of care. And as those hospitals fill up, because keep in mind, they’re already operating at capacity most of the time, even pre COVID, that gets more and more challenging. So that’s another aspect of this that I think we definitely need to keep in mind. I know it’s something that public health officials monitor closely, which is great. But again, we need to be mindful of the system we’re in and the limitations of it.
The other factor, I think, is the burnout of healthcare professionals. They’ve been working around the clock for this pandemic since it started. You can imagine the frustration right now when essentially every person, almost every person needing critical care right now in Canada is unvaccinated against COVID. These are preventable admissions to ICUs. So I think as a society again, we need to step up and protect our health care system and the people that work in it.
Jordan Heath-Rawlings: What could we be doing to better protect those people? I know mandatory vaccinations, obviously, would be a huge help, but I’m thinking specifically of the kids here, how quickly could we activate more critical care beds for children? My understanding is it takes a different set of skills to man those beds, really.
Dr. Katharine Smart: No, it does. We always say Pediatrics children aren’t just little adults, and that’s true as well when it comes to critical care. But I certainly wouldn’t want people to not have confidence in our systems. I think what we’ve seen is people stepping up pivoting and being creative to get Canadians the care they need. And I know all of us in Pediatrics would do that if that’s what it came down to, to make sure children got the care that they needed, that would be redeploying staff, changing the way our hospitals are laid out to make sure the kids could be accommodated. But what people have to realize is that then means other services aren’t going to be able to be provided. And that’s what we’ve seen in the adult system, cancellation of diagnostic imaging, elective surgeries. We have a huge backlog of people now waiting for care because their care was displaced by people with COVID, and that also poses a risk to kids. So, you know, again, I think the biggest thing any Canadian can do right now to protect the system is choose to be vaccinated themselves.
Jordan Heath-Rawlings: One other thing I wanted to ask you about is non-COVID illness in kids. Again, speaking of my own kid, but also hundreds of thousands of kids in this situation who has not been in really close congregate settings with dozens of other children in more than a year now. Are we going to see an incredible spike in the daycare illnesses, not to have any better way to put it, as kids go back to school?
Dr. Katharine Smart: Yes. We’re already seeing that we’re seeing around the world spikes and things like RSV, parainfluenza, influenza in children. We’re starting to see that here in our hospitals in Canada as well. And those are diseases that we see every year and cause a spike in visits and hospitalizations over the fall and winter regardless. But absolutely. I think there is a concern that those things may be worse for kids this year because their immune system sort of had a break from fighting these various viruses off. We’re also going to have a cohort of kids, younger children who weren’t exposed to any of these viruses in their first year, year and a half of life because of the mitigation and things that were in place for COVID. So that’s a concern as well.
And then, of course, the other thing we’re learning about is what does it look like if you get RSV and COVID at the same time? So these, again, are all reasons why those of us who care for children are a bit nervous going into this fall in winter. And it’s again, another reason for people to really think strongly about masking, hand hygiene, all those other things that help protect kids from the day to day viruses that we often see and that often fill our hospitals.
Jordan Heath-Rawlings: Last thing I’ll ask you, and it’s because I know you’ve got lots of experience talking to anxious parents is what would you say to parents right now who are just really worried and scared? And, to be honest, frustrated? I think when I think about the situation in terms of back to school, the thing I feel most is helplessness because it doesn’t seem like there’s anything I can do. I’ve been vaccinated, obviously, taking mitigation measures. There doesn’t seem to be anything I can do but send her to school and pray, really.
Dr. Katharine Smart: Yeah. I think the biggest thing I would say is I see you and I see how scared you are. Obviously, there’s nothing more precious in a parent’s life and their children, and there’s nothing worse than feeling helpless when it comes to the health of your children. So I think what I would say is there’s lots of us out there advocating for you, bringing up these issues, pushing for these decisions to be made to keep your kids safe. We believe strongly in wanting children to be able to go to school and be safe and to keep our community safe. So we’ve got your back, and we’re doing what we can to bring these messages forward.
I think also to reassure parents that we’re going in the right direction in this country. We have a very high immunization rate. We’re starting to put things in place to get those few people that haven’t chosen to be vaccinated over the finish line. And I think we’re going to see more uptake in vaccine here over the the next few weeks and months, and that will protect your kids. And, you know, most children are very resilient and do very well. I feel confident that if we have children that do need care, do you need high levels of care, we’ll be able to take care of them, get them safely through these illnesses. But the bottom line is we want to keep those numbers as small as we can. And by encouraging your friends and family and your communities, to step up and be vaccinated and be safe, we can all work together, I think, to get to where we want to be, which is a safe outcome for our kids and families.
Jordan Heath-Rawlings: Dr. Smart, thank you for that. I needed to hear it, and thank you for this whole conversation. I know it’s a worrying topic, but it’s one I think we all have to discuss.
Dr. Katharine Smart: I really appreciate you having me on your show.
Jordan Heath-Rawlings: Dr. Katharine Smart, President of the Canadian Medical Association. That was The Big Story. For more from us, head to thebigstorypodcast.ca. Find us on Twitter at @TheBigStoryFPN. Send us emails telling us what you want us to cover, especially as the election campaign rolls on. We are trying to figure out what matters most to you so you can get the information you need to make your vote work for you. The email address is firstname.lastname@example.org. And of course, The Big Story Podcast is in all your podcast players, the Apples, the Googles, the Stitchers, the Spotifys, the PocketCasts, the Cast Boxes, etc.
Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.
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