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Detecting the young silent spreaders of coronavirus as Canadian schools reopen

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With just weeks to go until schools reopen across Canada, one uncertainty that remains is how effectively children can spread the coronavirus that causes COVID-19 to others — even when they don’t show symptoms.

“It’s now clear the idea that children don’t often get infected and don’t transmit the virus is mistaken,” said University of Western Australia epidemiologist Zoe Hyde.

“We know that children can transmit the virus, but we don’t yet know whether they can transmit as effectively as adults.”

While Canada has had fewer than 10,000 COVID-19 cases in those under the age of 19, including only one case where a child with the COVID-19 disease has died, experts say schools are uncharted territory because they have remained closed in much of the country during the pandemic.

Hyde argued in a new preprint article in the Medical Journal of Australia, which has not yet been peer reviewed, that while evidence shows children generally have less severe illness from the virus — it’s wrong to assume they play a smaller role in spreading it.

“Children are much more likely to have mild or even asymptomatic infections than adults, and so they’ve gone under the radar,” she told CBC News.

“However, as community transmission has grown in some countries, the virus has finally started to make its way into younger age groups, and large outbreaks in schools have followed.”

An outbreak at a school in Chile found younger children and teachers were more likely to be infected, while Israel saw an explosion of coronavirus cases after it moved to reopen schools quickly despite cases in the community being low.

An article published in JAMA Pediatrics last month also found children at a hospital in Chicago carried a similar amount of virus in their upper respiratory tracts as adults.

While that doesn’t necessarily mean they can spread the infectious virus as effectively, it did find kids aged five and under with mild COVID-19 symptoms had 10 to 100 times as much of the virus in their systems as older children and adults, so they could still be “important drivers” of the virus in the general population.

Could schools cause a surge of COVID-19 cases in Canada?

Given what we know and don’t know about the way in which children can spread the coronavirus, one question remains top of mind — will reopening schools next month put students, teachers and the wider community at greater risk?

Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa, said much of the research to date on how kids spread the virus is flawed because it was done while schools were already closed and cases in the community were low.

“We don’t really know to a large extent what happens in the school arena,” he said. “You cannot reliably conclude that child transmission is unlikely.”

 

Canada’s federal guidelines for returning students to school focus heavily on isolating those with symptoms but make little mention of asymptomatic transmission. (Shutterstock/Halfpoint)

 

Another caveat is that the research also focused largely on children with COVID-19 who were symptomatic, which Deonandan said leaves many questions unanswered for younger kids who are much less likely to show symptoms.

Ashleigh Tuite, an infectious diseases epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, said that there is an increased risk of spread in schools because children’s social circles are generally wider than adults.

“If you have 30 people in a classroom and each of those children has a social circle of 10 people and you have a case introduced into that classroom setting, you’re potentially talking about having to think about disease transmission among 300 people,” she said.

“We’re dramatically increasing the size of our social networks as we have this return to school, and if you have an initial case that is introduced into that setting in a child who’s asymptomatic, it may take time until you recognize that there’s transmission happening.”

Is Canada doing enough to stop asymptomatic spread in schools?

Canada’s federal guidelines for returning students to school focus heavily on isolating those with symptoms but make little mention of asymptomatic transmission. They also concede COVID-19 in children is “not fully understood” and “evidence may change with time.”

“From the very beginning of the epidemic, we have completely dropped the ball on understanding the role of asymptomatic transmission of this infection,” said Dr. Isaac Bogoch, an infectious diseases physician at Toronto General Hospital.

“To date, seven months in, we still don’t have a very good understanding of the proportion of people that are truly asymptomatic.”

Despite that lack of understanding, Bogoch says the current back-to-school protocols in place could work to address any potential asymptomatic spread in the classroom.

“If an asymptomatic person is going to school and they have a mask on the entire time and they’re washing their hands religiously and they’re separated two metres from other people, it’s far less likely that they’re going to transmit this infection to other people,” he said.

But new modelling from the federal government warns of the potential for a “fall peak” in coronavirus cases, adding that “closed and crowded indoor settings where physical distancing is a challenge pose high risk for outbreaks.”

WATCH | Potential ‘fall peak’ in cases of coronavirus infections:

Chief public health officer Dr. Theresa Tam says her team is striving for a best-case scenario but preparing for the worst: a so-called “fall peak” of COVID-19 cases across the country. 1:06

Rapid testing would be ‘a tremendous benefit’

Besides focusing on increased ventilation, physical distancing, masks and avoiding crowded indoor spaces as essential aspects of reopening schools safely, one other key element that could help curb spread before it starts is rapid testing.

“If there was a rapid test, that would really identify people that have enough virus in their system that they’re capable of transmitting it to others,” said Bogoch.

“This would be a tremendous benefit, because you could identify people who are at risk of transmitting this infection and prevent them from going to work or from going to school and infecting others.”

But Canada does not yet have access to this type of testing technology called antigen tests, which could allow schools to test entire classrooms quickly with results in about 30 minutes.

“Right now, trying to test people on a regular basis, and children in particular and teachers is not part of the approach,” Canada’s Chief Public Health Officer Dr. Theresa Tam said in a press briefing this week.

“If you had a case in your school, we expect rapid response in terms of testing and looking at contacts, but right now the technology in Canada doesn’t support that kind of approach.”

 

Chief Public Health Officer Dr. Theresa Tam says Canada is ‘actively pursuing’ rapid testing technologies, but to date no such tests have been approved by Health Canada. (Justin Tang/The Canadian Press)

 

Surveillance testing could help catch asymptomatic cases

The U.S. Food and Drug Administration recently authorized emergency use of antigen tests in the United States this month, which are already being rolled out in schools from kindergarten to Grade 12 in states such as Arkansas.

Tam said Canada is “actively pursuing” a similar technology for use here, but no antigen tests have yet been approved by Health Canada.

In absence of that, randomly testing classrooms with our current technology through what’s known as surveillance testing could help catch asymptomatic cases in schools before they spread.

But no provincial or territorial back-to-school plans in Canada have focused on surveillance testing in the classroom in order to monitor and curb potential asymptomatic spread.

“We definitely need to be doing surveillance testing in schools,” said Hyde. “At the very least, we need to be doing this kind of testing to get the data we need to work out how safe schools are.”

Some provinces, such as British Columbia and Newfoundland and Labrador, have opted to delay the start of their school year in order to better prepare for reopening in the pandemic. But others, like Canada’s most populous province, have opted to push ahead amid the uncertainty.

 

 

Ontario’s Chief Medical Officer of Health Dr. David Williams said Thursday there was a negligible risk of sending students back to school, citing low rates of transmission in the province.

“If there was a risk, I would not be recommending the schools are being opened under the current situation,” he said during a news conference. “Therefore, at this time, I don’t see those risks.”

Some experts disagree, citing flawed research that hasn’t provided a clear picture of asymptomatic transmission in children and the fact that COVID-19 has largely gone untested in Canadian schools with a second wave expected in the coming months.

“It’s inevitable. I think we are going to see a rise in cases, and it’s probably going to come in the fall. And I don’t think that’s lost on many people that are following this closely,” Bogoch said.

“We have to ensure that there’s good early detection systems in place so that we can rapidly identify outbreaks and respond to them before they spiral out of control.”

Source: – CBC.ca

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After long-term care, Quebec private seniors residences a growing COVID-19 concern – Pipeline News

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MONTREAL — A slow but steady rise of COVID-19 cases in Quebec’s private seniors residences in recent weeks is causing concern among experts and authorities, who want to avoid the disaster that befell long-term care homes during the first wave of the novel coronavirus.

As of Wednesday evening, there were 39 private residences in Quebec with 180 COVID-19 cases between them listed on the government’s website. Four among them were described as “critical” because more than 25 per cent of their residents were infected.

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In comparison, only 20 long-term care homes were listed as having cases. One facility was listed as critical.

Yves Desjardins, the head of a group representing hundreds of seniors residences, says the number of facilities affected and the total number of COVID-19 cases in the network remains low. He said, however, managers are watching the trend carefully.

Unlike the first wave of the virus, which was concentrated in long-term care, the second has the virus spreading throughout the community, according to health officials. Desjardins says community spread poses a risk for people living in seniors residences because they are generally more active than are residents of long-term care homes.

“We have a clientele that is much more autonomous, that move around, families coming to visit, workers coming to the residence,” Desjardins said in a recent interview. “The virus is circulating in the community, and we’re in the community.”

Health Minister Christian Dube has expressed concern about cases appearing in private seniors homes, known as RPAs. On Sept. 15, he tightened health directives in those facilities, mandating that masks be worn in common areas such as hallways and elevators.

“The RPAs, for me, that’s our next problem if we’re not careful,” he said on Sept. 15.

Seniors residences must record the names of guests, who are required to wear masks. Despite the rules, there have been some outbreaks.

The four seniors residences listed as critical are located in the Quebec City area and in the region to its south, called Chaudiere-Appalaches. The RPA called Villa Ste-Rose in Laval, north of Montreal, has seen cases jump from four to 18 in recent days.

Dube said this week that while some cases in seniors residences are unavoidable, public health is contacting each place to ensure infection-control measures are being followed.

Louis Demers, a professor at Quebec’s public administration school, known as Ecole nationale d’administration publique, says the province should be concerned.

By raising the salaries of orderlies in long-term care homes, he said the government may have lured people away from the public sector. That attempt to reverse critical staff shortages in long-term care has the potential to increase seniors residences’ dependence on employment agencies.

“If your personnel is insufficient, and you have to choose between not giving a woman a bath, or giving one by someone who might have the virus, what do you do?” he said in a recent interview.

A major issue that contributed to hundreds of deaths in long-term care homes in the spring was the fact employees worked in more than one facility, often carrying the virus with them to vulnerable and captive populations.

Desjardins said it’s nearly impossible to “100 per cent” ensure staff only work at one residence, especially when some health professionals come in and out to provide services.

He said, however, that owners of residences generally ask staffing agencies to ensure personnel don’t rotate between facilities. When it comes to professionals providing medical services, they are asked not to visit multiple places in the same day, he explained.

Both Demers and Desjardins said private seniors residences are better prepared to face a second wave than long-term care homes were prepared to face the first wave of the novel coronavirus last spring.

Owners have a set of clear guidelines explaining which measures to impose based on the alert levels in their regions, covering everything from visitors to cafeteria dining. Infection-control measures are now known and understood, and personal protective equipment such as masks are available, Desjardins said.

Demers said the population in seniors residences are healthier than in long-term care homes and generally live in their own small apartments, which makes distancing easier. They’re also less likely to suffer from cognitive problems such as dementia.

He believes the government’s biggest challenge when it comes to private seniors homes is to find the right balance of measures that will protect people from the virus while allowing them the social contact that’s essential to their mental health.

After witnessing the hardships caused by the restrictive measures placed on seniors homes last spring — such as including banning all visitors and limiting movement — there’s little appetite for another lockdown, he said.

This report by The Canadian Press was first published Sept. 25, 2020.

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Montreal reports 229 new cases of COVID-19, one more death – CTV News Montreal

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MONTREAL —
Montreal public health reported 229 new cases of COVID-19 on Friday, bringing the total number of cases in the city since the start of the pandemic to 32,292. 

One more person has died due to the disease in the city, for a total of 3,478. Quebec health officials announced that the death took place sometime between Sept. 18 and 23. Montreal’s data shows it was a person aged 80 and over. 

Montreal North remains the area most impacted by COVID-19, accounting for 2,808 of the city’s cases. Mercier-Hochelaga-Maisonneuve, Villeray-Saint-Michel-Parc-Extension and Cote-des-Neiges-Notre-Dame-de-Grace are the runners up with 2,634 cases, 2,589 cases and 2,564 cases respectively. 

As of Friday, there are 26 long-term care homes and public retirement homes with at least one confirmed case of COVID-19. 

Montreal remains “orange” or at the “level 3 warning” stage on Quebec’s regional COVID-19 alert map

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Quebec health minister asks people to avoid gatherings for 28 days as COVID-19 cases surpass 70000 – CTV News Montreal

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MONTREAL —
Quebec’s health minister is insisting for Quebecers to avoid social gatherings for at least 28 days. 

Christian Dube made the announcement at a press conference on Friday after the province surpassed 70,000 confirmed cases of COVID-19. 

“If we do this, I think that it’ll encourage people to understand that, yes, it’s an additional effort that we’re asking you to do, but there’s an end to it,” he said. “It’s for a month, it’s not permanent, we are asking you for one month of efforts to break this second wave.” 

In a news conference on Thursday, Dube specified he’s asking Quebecers to avoid dinners, barbecues, parties, and other such gatherings between people who aren’t part of the same bubble. The measure is an attempt to halt community transmission that public health says is the culprit of Quebec’s recent uptick in cases of COVID-19. 

“We’re saying make a small social effort now,” Dube said. “If we succeed, well, the curve — we will flatten it.” 

If members of the same bubble would like to dine together at a restaurant, they can do so, the government said. 

When pressed about whether restaurants and bars will close once regions begin entering the “red alert” level on the province’s COVID-19 map, public health director Dr. Horacio Arruda said it all depends on where the outbreaks in the province are coming from. If restaurants aren’t presenting a risk, they won’t have to close, Arruda said. 

Quebec health authorities reported 637 new cases of the disease on Friday, bringing the provincial total to 70,307 since the start of the pandemic. 

Friday’s update is the highest number of cases Quebec has reported over a 24-hour period since May 21, when it reported 718. 

Four more people have died in the province, for a total of 5,814. Officials say the deaths took place between Sept. 18 and 23. 

A significant portion of the cases have been recorded in the Montreal region (229, for a total of 32,292), while 132 cases have been recorded in Quebec City (3,483), 17 in the Eastern Townships (1,658), 38 in Chaudiere-Appalaches (1,098), 43 in Laval (6,831), 20 in Outaouais (1,230), 16 in the Laurentians (4,593) and 83 in Monteregie (10,281). 

Dube announced that the entire metropolitan region of Montreal and the MRC Riviere du Nord — including the Saint-Jerome area — are now in the “orange” alert level on the province’s regional COVID-19 alert map.

“The changes in the alert levels demonstrate the seriousness of the situation,” Dube said.

As of Friday, there are 199 people being treated for COVID-19 in Quebec hospitals, which is an increase of 15 from the number reported on Thursday. Of them, 33 people are receiving treatment in the intensive care ward, which is an increase of two over the past 24 hours. 

Quebec reported another 313 recoveries on Friday, bringing the total number of people who’ve recovered from the disease in the province to 60,256 — or 85.7 per cent of the cumulative cases. 

Quebec reported that it completed analyses of 36,060 samples on Sept. 23 (Quebec reports its daily testing figures from two days prior). Health Minister Christian Dube said on Friday that this testing update beat Quebec’s daily record. 

WHEN PUBLIC HEALTH CALLS

Public health said last week that only one third of the people it attempted to reach for contact-tracing purposes answered the phone. Citizens were quick to point out that the calls come from a blocked number, which creates confusion and prevents people from calling back. Dube announced on Friday that calls from public health will now be labelled “Sante Publique.” 

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