With Ontario students returning to in-person classes, the Ministry of Education recently announced it can provide up to 50,000 rapid antigen and PCR tests per week as a key element in its plan to curb the spread of COVID-19 and reopen schools safely.
COVID-19 testing is overseen by Ontario Health, a provincial agency responsible for coordinating health care. But much of the decision-making on how the tests will be used has been left up to individual public health units. Both the Ministry of Education and the Ministry of Health have said that’s because factors such as community transmission vary from region to region.
But the lack of specific direction from the province makes parents worry that there’s no cohesive plan, said Jessica Lyons, a member of the Ontario Parent Action Network and mother of three in Toronto.
“Testing is how we know where we’re at … It’s how we know where we’re at in terms of how effective safety measures are within schools,” said Lyons, who is also a community nurse.
The emergence of new novel coronavirus variants of concern — believed to have originated in the U.K., Brazil and South Africa and which appear to be more easily transmissible — makes a “robust” plan for testing even more vital as she prepares to send her two elementary school aged daughters back to school next week.
“I’m terrified of the variants,” Lyons said. “I’m really, really nervous.”
In a joint email response to CBC News seeking more details about how COVID testing will work, Ontario’s ministries of education and health said they were working with “mobile testing vendors to support the delivery of targeted testing in schools and child-care setting[s] across the province when local public health units have identified need.”
The email also said that if a student or teacher tested positive for COVID-19 with a rapid antigen test, they would be referred for a lab-confirmed PCR test — the test performed in COVID assessment centres — to confirm the result.
The Education Ministry also referred to an announcement from Premier Doug Ford’s office from Jan. 29 announcing that the province had ramped up laboratory capacity so it can screen all positive PCR tests to identify variants of concern.
However, the response did not make it clear whether or how the results of those tests would be linked back to schools to determine whether or not COVID-19 cases — including the variants of concern — were spreading there.
It’s also not clear how much support the province is offering in terms of people to actually administer the tests.
More clarity on how testing in schools will work is critical as in-person classes resume, said Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto’s Dalla Lana School of Public Health.
“The details matter,” Tuite said. “What you really want to see is an actual plan.”
“Obviously, each health unit or each [school] board, you know, may have different circumstances,” she said. “But, you know, you would expect that there would be some sort of guidance that’s provided by the province.
“You can tweak it as you need based on your individual circumstances.”
No testing details from Toronto, Durham public health
From the email CBC News received from the ministries of education and health, it appears the province is suggesting the tests should be used when public health units identify a school with a COVID-19 outbreak or in a community with a high rate of virus transmission.
CBC News contacted three public health units in the GTA to find out more about their plans for school-based COVID testing.
Peel’s Medical Officer of Health Dr. Lawrence Loh said his understanding was that Ontario Health would be providing mobile unit staff who would conduct asymptomatic testing and that Peel public health would direct them to where it was most needed. However, Loh said he was still waiting for confirmation of that, as well as more details from the province about what resources would be available to them.
Toronto Public Health said it would be unable to provide any information until later this week.
Both Peel Region and Toronto schools are reopening on Feb. 16.
Schools in Durham region reopened on Monday. In an emailed response on Friday, the Durham Region Health Department said it was “committed to working with local school boards to ensure the safe reopening of schools, which will include testing of asymptomatic staff and students as outlined by the province.”
A spokesperson for Durham Region Health said the department will provide “additional details to the community as more information becomes available.”
Loh said a pilot project in Peel where asymptomatic testing was conducted in schools late last year showed how important testing is in identifying COVID-19 infections that may otherwise have gone undetected.
The key, he said, is not only rapid testing, but rapid response when a student tests positive.
“When a case is detected in a school, we need to be very strict about rapid and automatic dismissals,” said Loh.
The student, as well as their cohort, need to be sent home right away to minimize the chance of spread to other students, teachers and staff. They will also receive lab PCR tests, which are the gold standard for COVID diagnosis.
Rapid tests can then be used on any other contacts in the school who aren’t part of the cohort, Loh said.
Loh also said he understands the province’s lab capacity has expanded after a backlog earlier in the winter and that labs will be screening positive test results for variants of concern.
School-based data needed
But in addition to rapid diagnosis, a provincial COVID testing plan for schools should also have a surveillance component, Tuite said — especially during this window when the rest of society is largely locked down and schools are the main place where people are gathering.
If COVID testing isn’t in place when schools open, she said, it’s a missed opportunity to gather valuable benchmark data to help answer a question that’s continually debated: whether or not schools drive COVID-19 transmission, or just reflect the transmission that’s happening in the surrounding community.
“The way to answer that question is to be really systematic about it — to, you know, come up with an approach to testing that will allow us to answer these questions in terms of, you know, what’s happening in our communities [and] what’s happening in our schools,” Tuite said.
“I think we’re going to be in a situation similar to where we were in the fall where we just aren’t going to be collecting that data.”
Several research studies from other countries suggest that schools do not appear to amplify transmission — but using school-based testing to generate Canadian data would go a long way in determining a more definitive answer, said Dr. Jeffrey Pernica, a pediatric infectious disease specialist at McMaster University.
“It would be very useful to do more coordinated, targeted testing to actually be able to verify that schools are as safe as we think that they are,” he said.
