‘It’s on us as adults right now’: An infectious-disease doctor on keeping kids safe at school

TVO.org speaks with Janine McCready of Michael Garron Hospital about preparing for fall, guarding against the Delta variant — and what the next school year could look like
By Nathaniel Basen - Published on Aug 19, 2021
Janine McCready is the associate director of infection prevention and control at Toronto’s Michael Garron Hospital. (Courtesy of Janine McCready)

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Ontario is preparing for a return to in-person learning this fall. Earlier this month, the province released its back-to-school plan. The Toronto District School Board later unveiled its own plan, with more stringent rules. 

But with the Delta variant proving to be more transmissible, and with children born after 2009 still ineligible for vaccination, many parents are wondering whether any strategy would be able to control the spread of COVID-19. 

Janine McCready is an infectious-disease doctor at Michael Garron Hospital, in Toronto’s east end. She’s also the hospital’s associate director of infection prevention and control.

In the community, McCready has worked throughout the pandemic to keep schools safe —advising educators and spearheading initiatives such as take-home testing.

As fall approaches, TVO.org speaks with McCready about what is being done to prepare schools, what students and parents can expect, and what more can be done to keep kids in the classroom. 

TVO.org: How are you? Have you been able to get some time off this summer? 

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Janine McCready: Yes. I was really lucky, I was able to get out to visit family in Alberta, before [the province] loosened some of their plans. We hadn’t seen them in quite a while, and my kids were very excited to see their new cousins. So that was amazing and very necessary. 

And then now, you know, back into it, and trying to maintain a positive outlook and see what we can do to mitigate Delta in the fall.

TVO.org: What about your work has changed since the last time we spoke

McCready: The last time we spoke, I think vaccines were becoming more available but weren’t quite fully available. So our vaccine work now has really shifted to reaching those who either haven’t had an opportunity to get vaccinated yet or have been more hesitant. Every additional person that we can get vaccinated is one less person that is going to end up exposing their family and their friends, and one less person who’s going to end up in hospital and in the ICU. So we’ve really focused on that and are trying to make an accessible strategy for people. We’re sending teams out to people’s homes to vaccinate them, and we’re calling people and making sure it’s an accessible occasion. 

And then, obviously, the last time we spoke, it wasn’t available for youth. So, from May onwards, we’ve been really trying to make sure we can get as many of our 12- to 17-year-olds vaccinated to help provide that safety level in the in the middle and high schools. 

In the hospital, fortunately, the number of people admitted with COVID over the summer has been very low. Unfortunately, in the last week or so, we’ve started to see a few more people get admitted — even some people who are critically ill, which is a bit demoralizing to see, to be honest, because we have these amazing tools with the vaccines that will almost perfectly prevent that. Some of these people are vehemently opposed to the vaccines, and now they’re critically ill. It’s emotionally really challenging, because anything that’s a preventable disease, it’s tough in medicine to see people suffer through that. We’re starting to see it a little bit, but it is almost exclusively in people that are unvaccinated. 

Same with when we’re calling people that have been positive for COVID: there are a smattering of people that are vaccinated and unfortunately have been exposed, but almost all of them have mild illness. 

And then the other thing now, with school coming very soon, is really just ramping up, making sure we have all our plans for schools in place: How are we going to promote vaccines, promote testing, make sure things are as safe as can be? And then also reaching out proactively to a lot of our daycares in the area to make sure that they have the support they need in terms of testing, because we do expect that, with Delta, things are going to get busier.

Agenda segment, May 6, 2021: Helping kids bounce back amid COVID-19

TVO.org: You’ve done a lot of work in areas such as Thorncliffe Park, which has lower vaccine uptake than other parts of the city. And I’m wondering, is it mostly an access problem? 

McCready: I think a lot of it has been access. At the beginning, it was kind of The Hunger Games of vaccination — so if you had a computer, and you could sit there all day and book it, then you were going to get the appointments. That’s now kind of fallen away, and vaccines are more readily available. But it’s still being able to go online to book it. We’ve really tried to make it easy — walk-in and right where people go — so, a lot of pop-ups. If you’re a young mom, and you have three or four children, or even one child, to be able to get yourself to a vaccine clinic, even if you don’t have to wait, it’s a challenge, right? Or if you’re working multiple jobs, if it’s not convenient at your workplace. We’re still finding people in those situations. 

We’ve tried to set up things in convenient locations, like Shoppers World, for example. One of my colleagues was telling me the other day, this 80-year-old man showed up, and they were curious, “Why did you wait?” And he said, “Well, I didn’t really wait — this is just the first time I’ve seen anyone and knew where to go.” 

The number of those people is shrinking, for sure, but we still have to make sure we make it as easy as possible. 

And I think there’s also a cohort of people where there is a bit of mistrust in the system; we’ve seen this in some of the data for people that are new Canadians or refugees, that they’re maybe a bit afraid, and they don’t know if they are they actually eligible. Can they get it? They don’t know if they are going to get in trouble in some way. Having dedicated strategies for those people, too, is important, because we’re going to see spread within these communities, as we did before, if you have an unvaccinated pocket. 

TVO.org: And then with the kids between 12 and 17, there’s a bit of a time crunch: the more vaccinated kids before school starts, the better. Are you encouraged by the vaccination numbers in that group? What needs to be done there? 

McCready: It was pretty amazing the way that youth were keen to get vaccinated. There are probably still some pockets and some work to be done in some communities — I would love to have 100 per cent of kids vaccinated unless there’s a medical reason they can’t. I’m not going to be happy until every single child that is able to get a vaccine is offered one and know that they can have it. But I’ve been pretty encouraged by our vaccination rates. 

In the communities where we saw a lot of spread, I really hope those schools can have a much different year than they did last year and a much safer year — and having the middle-school and high-school kids vaccinated and their parents vaccinated is going to translate into a much safer environment for the elementary kids, too, hopefully. 

One thing we’re doing is contacting most of the people in those communities and then sending mobile teams to their house. Not just the youth — we’ll vaccinate their entire family if they’re interested. We’ve had a lot of success with that. 

I think there are still some that haven’t had a chance. And then now the government is allowing all kids turning 12 this year, so all the 2009 babies, to get vaccinated, because then basically anyone going to middle school is going to have that opportunity to be vaccinated. 

Over the next few weeks, we have to make sure those kids know they’re eligible, and you should give them easy access. Our plan is to look at the areas and then basically offer vaccines in schools for the first few weeks as well.

TVO.org: Working on the back-to-school plans is such important and charged work, and it happens out of the public eye — what has that experience been like? 

McCready: I have no official role in any of the actual forming of the rules; that’s done by the school boards with the expertise of Toronto Public Health. I did have the opportunity to weigh in on a science-table brief in terms of back-to-school recommendations, and it was a very interesting process, because to try to get people on the same page — there was very broad stakeholder involvement. You have people that have very different opinions on creating the safest environment for kids. The goal is to keep them in school and keep them safe but then still allow them to be kids. There was a lot of interesting debate that way. 

There was a lot of consideration given to the current climate with Delta, because the infectiousness of the variants we’re dealing with right now influences what the restrictions are. It was helpful to think of it as a framework, like a sliding scale. So, you’re starting in a higher-up area at the beginning of the year, when we don’t know what really is going to happen, and maybe you have tighter restrictions. And then the hope, for a lot of us, is that, as the year goes on, and as vaccinations are offered to those under 12, then maybe some of those restrictions could be loosened up. And, gradually, we’ll look more and more normal as more of the population is protected. 

TVO.org: There are lots of different rules: some from the province, some from school boards. Individual schools will have some rules. What can parents and kids in Toronto expect when they walk into a classroom — both physically, with things like ventilation, and also with rules and restrictions?

McCready: I think, generally, things will be similar to last year in terms of some form of screening before you walk in the door. So if people have symptoms, please don’t come to school: stay home, and get tested — especially if you’re under 12, unvaccinated, or have someone in your household that is unvaccinated. I don’t know if the screen is going to be exactly the same or if they’re going to narrow it down to some key symptoms. 

Once you’re in school, it seems like almost all the districts are going have mandatory masks, which I think is definitely a good move. It sounds like they have tried to do a lot of work on the ventilation systems in the schools, and there’s a lot of talk about HEPA filters in the room, so you might not actually physically notice anything different, but we’ve been told that there have been improvements made. That’s encouraging. 

Class sizes is one question that I haven’t seen a concrete answer on. I don’t know what they’re going to do that way, and I think that’s probably something that, now that they have a sense of how many kids are returning in-person, there’s going to be a lot of work to be done on what those classrooms look like in the next few weeks.

It sounds like the cohorting — basically, staying with the same group of kids, at least for the elementary kids — throughout your day is going to be very similar. 

In east Toronto last year, we had launched the low-barrier take-home self-collection testing kits, and now the rest of Toronto is trying to roll those out to pretty much every school in the city. That’s wonderful. And the province also is using that same model and rolling it out as a pilot at some schools across the province. My hope is that the pilot will be extended, and then everyone will have easier, lower-barrier access to testing, so that kids can get back to school faster if they do get symptoms, and also we can detect cases faster, since Delta is so much more transmissible and has a shorter incubation time. 

So I don’t know if school will look all that different from last year when you walk in the door. If you’re a high-school or middle-school student and you’re vaccinated, I think there should be much less disruption for learning, because, if you have a case in your class, ideally, you get tested and come back to school. You don’t have to isolate, like last year. Another reason to get vaccinated if you’re 12-to-17 is that, if you have an exposure in your class, you’ll be the one left out; you’re going to be the one at home online learning. So you can not only not get sick, but also stay in school. 

TVO.org: The medical officer of health announced mandatory vaccination for education workers. I know you work with educators and principals — what’s the reaction to that that you’ve heard? 

McCready: I haven’t heard too much since it just came out [Tuesday]. In speaking to friends, or some of the principals that are now my friends, most of them feel that it’s going to make the school safer. If anything, some people think that it would be better if we even went further. I think this helps — either you have to do a test or get vaccinated — but we should really be encouraging people to get that vaccine. One of the things I’m hoping to offer to the schools is making sure that people who have concerns have someone to speak to, to address that. Doing an online module is one thing, but actually having a conversation with a physician who can answer all their questions and try to allay their fears, I think, is potentially quite helpful. 

The other thing — this is not, or it doesn’t seem like this is on the table — but just speaking to the people that run private schools, they say, “What can we do to make the school safer?” And if you’re an under-12 school but all your parents and teachers are vaccinated, obviously there’s much less chance of having any introductions into the school. So really encouraging, not only the students, but getting whole households to have as much opportunity to get the vaccine. That’s going to provide the protection more than anything else. 

Agenda segment, May 7, 2021: Are Ontario's kids in crisis?

TVO.org: You’ve spoken about Delta, and data from the United States seems to show that kids are being infected more and more, and there are concerns about long COVID, serious illness, etc. You’re working with these schools, but you’re also a parent: How confident are you in sending kids back to school? 

McCready: I think that the trouble with my view is that I always see the worst-case scenario. I’ve called thousands of kids, and the vast majority have been just fine, right? They’ve had mild symptoms, they’ve recovered quickly, and they’re okay. But we had a child admitted recently who was a young, healthy kid — and that’s rare. But my worry is that, if enough children get sick, then we will see those rare outcomes. 

The thing to understand is what’s happening in Florida and Texas, while frightening, is they’ve really kind of let it rip. They have mandates that you’re not allowed to have a mask mandate. The way we’re going to look here is going to be a lot different than in that environment. Plus, their vaccination rates are lower than they are here. 

But I do think that we need to be cautious. I appreciate the way that Toronto Public Health and the TDSB have kind of taken a more restricted approach to the start of the year to make sure we do everything we can to limit the spread. We really have yet to understand how explosive Delta is and how much it will spread within these control measures. We owe it to the kids to do everything we can to make sure that we aren’t seeing explosive, widespread transmission within the classroom. 

So, cautiously, I’m planning on sending my kids back to in-person school. I do hope that everyone really takes personal responsibility and gets themselves vaccinated to provide that extra layer of protection as we head back, because it’s really on us as adults right now — and it’s to protect the kids. 

TVO.org: Is there anything else that you would like to see happen in schools before the fall or anything that we haven’t covered yet? 

McCready: Last year, I found it troubling that, with virtual versus in-person learning, there was a big discrepancy between different communities. The higher-socioeconomic-status communities, it was almost 80 or 85 per cent of kids that had opted for in-person learning; in some of the areas that had been harder hit by COVID, it was closer to 50 per cent. By mid-year, it had fallen below 50 per cent. So I see the large data from the TDSB, that over 80 per cent have opted for in-person, but I worry about what that breakdown will look like across the system. 

If we’re still seeing large pockets of the communities that were the hardest hit having lower enrolment in schools, especially for the younger grades, what more can we do to make sure those schools are safer and then also provide the parents support to send their kids back to school? I’m sure there are multiple reasons for it, one of which is probably they’re worried, and one of which is maybe they can’t afford to miss work if the kids get sick. As we’ve been saying, things like paid sick leave are still important.

We’re entering a new phase of the pandemic, but I think that that’s something that is still important to keep families safe and to keep kids safe. If you can’t afford to stay home with your kid if they’re sick, then a lot of this falls apart, right? Some of these kids have been out of school for more than a year. We really owe it to them to make sure that we’ve given them every opportunity, such that, if they if they want to be back in the classroom, they feel safe in that environment. 

In the interest of full disclosure: since it was created in 1970, TVO has been part of the province’s delivery of distance learning. Today, TVO offers online secondary-school courses through the Independent Learning Centre; it has been asked by the province to help implement a provincial online-learning system in Ontario.​​​​​​​

Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.

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