Quebec public health experts divided over decision to reopen schools

Premier Legault and his public health director are risking a sharp increase in COVID-19 infections among adults, say critics
Photo: Photo by Mwesigwa Joel on Unsplash
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This article originally appeared in the French edition of Ricochet and has been translated.

Sending children back to school “risks causing a sharp increase in the disease in the adult population,” warns Quebec’s institute for public health in an April 22nd notice about COVID-19, which the province’s public health director seems to have disregarded.

In the event that schools reopen, “it is certain that the infection of children would contribute to substantial transmission of COVID-19 to their parents and to other adults around them and could thus result in a large number of hospitalizations in a short period with a real potential to exceed the capacity of the health system in both large urban centres and in the regions,” says the notice, issued by the Institut national de santé publique du Québec (INSPQ).

Titled “COVID-19: Herd immunity and the return of children to school and daycare,” the notice also says that a “strategy to achieve herd immunity risks causing massive numbers of hospitalizations and deaths.” The day after its release, Quebec’s public health director Horacio Arruda and Premier François Legault advocated for the use of a herd immunity strategy.

They finally changed their minds on April 27, after Theresa Tam, Canada’s chief public health officer, said the effectiveness of a herd immunity strategy had not been proven — but they then brought up other reasons for reopening primary schools in mid-May.

Legault and François Roberge, the education minister, said the decision was based on public health recommendations. In fact, these are Arruda’s recommendations, and certainly not those of the INSPQ.

“Even if COVID-19 cases among those under the age of 70 have a lower risk of death than those who are older, a non-negligible proportion develops a severe infection requiring admission to intensive care and sometimes leads to death,” says the institute.

“In the current context of significant distancing measures, these adults under the age of 70 constitute 65% of laboratory-confirmed cases and approximately 35% of hospitalized patients. These proportions could increase if children bring the infection home.”

This risk of transmission to adults is not theoretical, according to experts at the institute. Children and adolescents have a great deal of contact with each other, as well as an average of five or six contacts per day with adults between the ages of 18 and 60. Since a large proportion of infected children are asymptomatic, they will not be suspected of having the virus and will transmit the disease.

The only way to prevent school reopenings from being accompanied by an increase in transmission among adults would be to have strong social distancing measures, concludes the INSPQ.

Experts do not have to say it is unrealistic to implement such measures with young children — it goes without saying.

Even if classes are few, even if desks spaced, nothing will prevent the children from approaching and touching one another in the playground.

The great dilemma

Are Arruda and Legault ready to take the risk of adults falling seriously ill when elementary schools reopen? Ricochet could not ask them because the Quebec Parliamentary Press Gallery refuses to accredit new media.

They have the support of Quebec’s Association of Pediatricians, which argues it is harmful to keep young children at home too long for several reasons.

First, authorities have noted a decrease in reports of violence against minors, which is a bad sign. Far from having subsided, violence has likely increased as a result of confinement but is less likely to be reported. Pediatricians also argue that children are in dire need of group contact. Finally, children from disadvantaged backgrounds no longer have access to the food aid programs available in schools.

Pediatricians care about the well-being of children and recognize the harm of not reopening schools. On the other hand, sending children back to school means adults, including parents, could die.

Most importantly, the epidemic could start again. This is the fear of experts at the INSPQ, who have the interests of everyone — children, adults and the elderly — at heart.

The popularity of Dr. Arruda

Le Dr Horacio Arruda, directeur de la santé publique du Québec, a joui d’une grande popularité depuis le début de l’épidémie de COVID-19. Mais son appui maladroit à la stratégie d’immunité de groupe, puis sa décision de recommander la réouverture des écoles primaires dès la mi-mai, le mettent en porte-à-faux avec les experts indépendants.

Dr. Arruda has enjoyed great popularity since the start of the COVID-19 pandemic. But his clumsy support for the strategy of herd immunity, and his decision to recommend the reopening of primary schools in mid-May, put him at odds with independent experts.

A similar divergence has manifested in France, where a scientific council of experts, convened to provide advice to the government on COVID-19, opposes President Emmanuel Macron’s decision to reopen schools before September. This has undermined the confidence of the French, who see their government is not following the recommendations of its experts.

In Quebec, two separate organizations are responsible for public health.

First is the INSPQ, which is headed by Dr. Nicole Damestoy and whose experts have warned against reopening schools. The institute is run by a board of 15 directors, eight of whom are unrelated to the government. Its primary mission is to make available its expertise, as well as its specialized laboratory and screening services. It has often taken positions in opposition to government policies.

The other organization, the Direction générale de la santé publique, is headed by Dr. Arruda, who supports returning children to school. It reports to the minister of health and social services. Dr. Arruda is assistant deputy minister, a high position in the public administration. Though the organization has partial autonomy, it is limited by the close relations it has to the political level.

Dr. Arruda’s recommendation to reopen schools in mid-May appears all the more dangerous since neighbouring Ontario — which, in proportion to its population, has far fewer deaths caused by COVID-19— has decided to wait until the end of the May to do the same.

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