‘We’re still in the dark’: Epidemiologist Colin Furness on COVID-19 in schools

TVO.org speaks with the U of T professor about rapid testing, airborne transmission — and what we do and don’t know about Ontario schools
By Nathaniel Basen - Published on Oct 14, 2021
Colin Furness is an infection-control epidemiologist and an assistant professor at the University of Toronto. (Courtesy of Colin Furness)

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On Thursday, Ontario reported 117 new student cases of COVID-19 in its publicly funded schools and five new cases among its teachers. Four schools are currently closed due to an outbreak. 

Meanwhile, debates about rapid testing, mask use, and vaccine mandates continue. And many parents are asking: Is the province doing enough to protect students in the classroom? 

TVO.org speaks with Colin Furness, an infection-control epidemiologist at the University of Toronto, about student privacy, how to keep kids safe, and which parts of Ontario’s response have left him “disappointed.”

TVO.org: Let’s start with the widest possible view. We’re more than a month into the school year now: How are we doing?

Colin Furness: Well, it could be worse. But obviously we’re not doing the sorts of things we need to do to be certain that schools are safe — we’re not pulling all the levers. We pulled a few of them. 

Right now, we’re muddling along, but cases continue to rise. The problem is, we don’t know how much they’re going to rise, because of all the factors at play. I know what would happen if we had no protections, and I know what would happen if we had all the protections, but because we’ve done only some, it’s just not clear to me how bad it might get. My overall feeling is that there are going to be winner schools and loser schools — that is, schools that, through a combination of built form, socio-demographics, and just bad luck, get clobbered, while some schools get away with it because they’ve got better ventilation, because they’re in a richer district, or because they didn’t suffer the bad luck of a super-spreader event. It’s much less predictable than other kinds of situations are. 

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We’re also still just getting started. Yes, kids have been in school for a month, but they’ve only been in school for a month. If you look at what’s happening with Alberta’s COVID meltdown, it took two months after the Calgary Stampede for it to really pick up steam, and that’s how exponential spread works. Things in school, there’s no question they’re going to get worse before they get better. There’s no question, but we don’t know how much worse.

Agenda segment, March 17, 2021: How COVID-19 spread in Canada

TVO.org: I want to talk to you about some of those levers in a second, but, first, a more general question: How can we actually evaluate how we’re doing? What does existing data tell us, and what doesn’t it tell us?

Furness: That’s a really hard question to answer. We don’t do systematic testing in schools. We have a track record over the last 20 months of under-testing kids, so, consequently, we actually have a really poor understanding of COVID dynamics in kids. There was the early belief that somehow kids don’t get it that bad, and it turns out that kids younger than, say, 10, seem to get it only about half as often and transmit it about half as often. It’s still not totally clear why.

So, unfortunately, everything that we want to say or know about school transmission is predicated on limited, faulty measurement and really limited understanding. We’re still in the dark, and that was forgivable in the early days of the pandemic, but to me it’s not forgivable now. Last September, we should have been really collecting data around related infections in schools, around the built form, around carbon-dioxide levels, ventilation — every case in school should be actually attached to that data so we could spot patterns and find patterns. We haven’t done that. So what does the data say? The data say we’re in a dark room, and that’s not a good place to be.

TVO.org: I assume that increased testing is one of those levers you were talking about. There has been some debate as to whether rapid tests should be deployed in schools, and now some are being rolled out to high-risk schools. What should the strategy be for increasing our testing of students in Ontario?

Furness: Let’s start with your comment about high-risk schools. Our chief medical officer of health has said, you know, schools that are in high risk communities: we know where there are lower vaccination rates; we know communities where there are higher COVID rates. But those aren’t necessarily the highest-risk schools. In other words, a school that is not in a high-risk community but has really poor built form, really bad ventilation, may be at much greater risk. We don’t know that, because we haven’t measured it, so we have not actually aligned our very limited testing strategy with certainty around where risk actually is. We’re still operating in the dark. So, to me, that’s a half-measure that’s not even sure to be calibrated with where the real risk is. 

Obviously, yes, rapid testing. I would love for us to be like Nova Scotia. We don’t actually have to control everything; we don’t actually have to line kids up and swab them. We can make tests available to parents, and, when there is a positive case, we can go into schools and either do rapid testing or PCR: you take your pick. We need a clear strategy to do that to be really responsive. The more we can democratize rapid testing, the less we try to control it, the better we’ll be. 

Before Thanksgiving, my family made sure that school-aged kids got rapid tested, and we had to really pull connections in order to make that happen. That should have been easy. I’ve got all the wherewithal to figure out how to get that done; a lot of people don’t. It’s not just what’s happening in schools — it’s what’s happening in families with school-aged kids, so democratizing rapid testing would be a really important thing to do. 

The big lever, though, the really big lever, is: we should only have staff who are vaccinated present in schools. If a staff member is not vaccinated, I don’t want to fire them. I want to assign them to virtual schooling and remote work, so that everyone can do what they were trained to do, but you’re not actually mixing unvaccinated teachers with kids. That should absolutely not happen. 

You know, a little bit less than 80 per cent of teachers are vaccinated, so this is not a tiny problem. This is a big problem: 80 per cent sounds high, until you realize it means that one in five classrooms has an unvaccinated teacher at the front of it. That’s unacceptable to me: you’re manufacturing risk. The fact that the teachers then have to do some rapid testing once in a while to me is not enough. It’s just not enough. 

As for high schools or middle schools, from Grade 7 up, we can say the same thing for kids: if you’re not vaccinated, then you should be doing remote schooling. If we had only vaccinated people in middle and secondary schools, they would be safer, and we wouldn’t actually need sophisticated rapid-testing protocols — we really wouldn’t. The situation is obviously a lot more fraught in primary schools, where none of the kids are vaccinated. All the more reason that only vaccinated adults should be in that building at all.

These are really obvious things. Certainly, as far as rapid testing goes, in my scenario, we don’t need much rapid testing in middle schools and secondary schools, because everyone’s vaccinated. In primary schools, yeah, you’d be doing it. You’d be doing representative testing. You can even do pool testing: everyone spits in the cup, and then you test the entire class in one go. 

There are really efficient ways to do this, and it would be reassuring to parents. A lot of the problem we have with COVID right now is mental health. Families are really stressed out because they don’t know — when their kids go off to school, it feels like an unmeasurable risk. Well, it is an unmeasurable risk. That’s avoidable. We could certainly be reassuring families. Instead of insisting that schools are safe, we could be demonstrating that. 

If we find kids through asymptomatic screening that are sick, then we go back and we’re able to find families that are infected, and we can actually control community transmission by paying attention to what’s going on in schools. We’re not doing that. 

TVO.org: Hopefully, relatively soon, vaccines will also be available to younger students. How should schools prepare for that, and how might that affect the student experience as far as looser restrictions go?

Furness: I think we’re really at risk of serious spread in primary schools until we get that done. I think we need to be really restrictive in all things — extracurriculars, no. And kids shouldn’t even be bused. I mean, there are a lot of things we shouldn’t be doing. But if you want to talk about possibilities post-vaccination, I circle right back to: It’s not good enough to vaccinate kids five to 11. You actually need a rule that says only vaccinated kids and teachers need to be at school. And once you do that, then you can have extracurriculars, then you can have band class, then you can have indoor gym class, and then you can start to do all those sorts of things. It’s vital that we get kids vaccinated as quickly as possible, but if we actually want schools to be normal, as well as safe, we want to limit in-school participation to people who are vaccinated: staff and students.

Agenda segment, October 8, 2021: Rapid tests: The key to ending the pandemic?

TVO.org: Another one of those tools that help against COVID-19 is proper masking. There is still debate as to what types of masks teachers and students should be wearing: What’s the answer there, and are you at all surprised that we’re still having these discussions? Should we not just have a standard by this point?

Furness: Yes. Surprised, no, because I think I can understand that — I think I can understand the dysfunction. But I am really disappointed. It’s hard to find the scientist anywhere who doesn’t accept airborne transmission. There are some, and most of them work in infection prevention and control, ironically, so they’re closest to it. They’re really the most committed to the conventional wisdom, and they’re sticking to it. But, and partly as a result of the influence of that group, Ontario has not acknowledged airborne transmission. Our CMOH has not acknowledged airborne transmission; the Ontario COVID-19 Science Advisory Table, as a group, has not acknowledged airborne transmission. So when no one making decisions has acknowledged, officially, airborne transmission, you don’t then have a justification for changing guidelines. And then guidelines end up becoming not just conventional wisdom — they end up becoming the rule of law. 

So you have so-called droplet precautions for droplet spread, and droplet precautions involve a simple procedure mask, a medical mask: fairly low-grade, ill-fitting, loose-fitting medical masks. Those have an effect — they do promote safety — but they’re not great. They’re okay. Any idea that we should be doing something safer than that is stymied by a lack of justification for it, officially, in terms of, “It’s not airborne, so that’s not needed.” 

The situation was more acute in January when I became aware that long-term-care home personal-support workers who were working with COVID-positive patients were being denied  N95 masks. In fact, IPAC [infection prevention and control] teams for hospitals would show up, do inspections, and remove N95 masks from the premises, and what they would say is, “The guidelines say for large-droplet transmission you do not need these masks.” What we knew were incredibly dangerous, lethal environments — long-term-care homes filled with people who are suffering from COVID — and, in those situations, we were taking masks away. We’re seeing the same thing in school boards now, where a school board was mandating the blue procedure mask, and you must wear that because it’s our policy, and when we do a policy, everyone has to conform. We have a standard approach, so it’s defensible. 

It’s not only that school boards are not actually stepping up to the reality of airborne transmission. They’re actively denying it. I know one teacher who is a primary-school teacher who has a child at home, so they’re going to work with a roomful of unvaccinated kids, and they’re going home to their own unvaccinated kid, and they want to wear a KN95, and they ought to wear a KN95, and it’s brutal that they’re being compelled to not do that. It’s demented, and it all gets down to a refusal to recognize, at a policy level, that COVID is airborne. 

Once you do that, then you’re going to have a whole spate of unsafe work refusals, and you’re going to have to acknowledge that we do not have safe hospitals in Ontario. The ramifications of declaring COVID airborne are actually really huge, and that’s why no one wants to write it down. That’s why no one wants to say it officially: because no one wants to declare hospitals unsafe. No one wants to see a whole lineup of work-refusal petitions by unions; it’s disruptive. The problem is that COVID is deadly, and I would choose disruptive over deadly.

TVO.org: After a student tests positive, a number of steps get set in motion. People are notified, people are isolated, but there’s much debate about who should be notified and who should be isolated. Should classmates of siblings of a positive test be notified? Should people know what class the positive test originated from? What do you think should happen? 

Furness: What should happen, ideally, is that you do ring testing: you test all the way around the child. You test every member of the family — you might even test one more connection beyond that — you test everyone in the school, and everyone in the class. So you test all the way around that person. It’s sort of like going and looking for cancer in someone’s body: you test lymph nodes, and if you find one that’s got cancer in it, you go to the next one, and you keep going. So, you ring test all the way around cases, and you need to do that immediately. That’s not happening, or it’s not happening to the degree that it ought to. I hear some cases that siblings don’t have to isolate. Of course that’s foolish. Ring testing all the way around is the way to go.

TVO.org: I might be remembering wrong, but I have memory of being in school and getting letters saying, “A child in your classroom has lice,” for example. Why is balancing personal privacy so important in this case, when we’re in a situation that does require some level of transparency?

Furness: There’s no question: I’m a privacy advocate. And I think most people in public health are. Sometimes privacy is too privileged. It’s a moral decision. The way common practice has been is that public health will actually prioritize privacy over just about anything else, and I think most of the time that makes sense, but maybe some of the time it doesn’t. When you’ve got a deadly global pandemic, I would tilt toward more transparency. But, certainly, when we’re talking about vulnerable people (and kids are vulnerable people), privacy becomes even more paramount. It really does.

It’s kind of a lose-lose: protecting privacy really limits our responsiveness, and that puts everyone, including the family of the person, in more danger. We actually manufacture danger by privileging privacy. I’m pro-privacy, but I don’t think we’ve struck a great balance. I also don’t think that, simply by saying a child has tested positive, we are necessarily outing that child. It’s complicated, because of course there’s a child-and-parent rumour mill, so you go ask your kid who is absent from school today, and they get the scarlet letter. That happens anyway. It seems to me that providing a little bit more transparency might actually temper the rumour mill a little bit. It’s really complicated terrain, but just suffice it to say that, when you’re dealing with personal health information and you’re dealing with minors, public health is going to be really wary; they’re going to be really cautious. They don’t want to get sued. And, also, just culturally speaking, privacy is this line you don’t cross. The privilege of privacy over public safety is a long-standing pattern.

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

TVO.org: Is there anything else you think we should talk about that we haven’t touched on yet?

Furness: I gather that not all classrooms actually have HEPA filters, and I really want parents to look at that carefully, and I want them to talk to their principal — I want them to talk to their trustees, actually. A HEPA filter is not very expensive. They are probably really effective. It’s curious that Ontario decided to invest in tens of thousands of HEPA filters while at the same time denying airborne [transmission]. But I’ll take the HEPA filters. 

We may not be giving as much credit to HEPA filters for their protective effect in the classroom as they deserve. And we don’t know; it’s somewhat speculative. I can’t guarantee that you can slap a HEPA filter in your kid’s class and your kid is safe, but given what little we know of COVID transmission in schools, it’s very likely that the filters are playing a significant safety-promoting role. It’s really tragic that, you know, for the $100, or the cost of the HEPA filter, that any class would go without. 

So I would like to see parents, communities, teachers, principals, and school boards getting onside and saying we’ve got to find money to put HEPA filters in classrooms, and they should stay there beyond COVID. It’s not even just a question of “we need this as a temporary emergency measure.” No, actually, indoor air quality is going to be something we’re going to be talking about for years, so we might as well start making those changes to our thinking and to how we think about classroom safety. We should be thinking about that structurally now — not temporarily, but structurally and urgently. So I want everyone to ask their child, ask the teacher, “Is there a filter in your classroom?” And if there isn’t, raise Cain.

This interview has been condensed and edited for length and clarity.

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