‘You can’t open in January’: An infection-control epidemiologist on Omicron in schools

TVO.org speaks with Colin Furness about holiday gatherings, rapid tests, and why he says schools can’t reopen on schedule
By Nick Dunne - Published on Dec 23, 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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Education and childcare settings are home to more than half of the ongoing COVID-19 outbreaks in the province — a pattern that has been consistent for months.  On November 1, 93 of the 169 outbreaks in the province were in schools and childcare settings, according to provincial data. On December 1, four days after the first case of Omicron was detected in Ontario, there were 416 outbreaks in Ontario, of which 224 were linked to educational settings. As of December 22, there are 764 outbreaks Ontario, of which 426 are in elementary, secondary, and post-secondary schools.

Natalie Philippe, a public health nurse for Public Health Sudbury and Districts, says that a school outbreak does not always involve transmission within the school. Instead, it is declared when two cases are reported in a single classroom. Often, she says, “outbreaks that occur in schools are actually from contact that occurred outside of school.” Her region has been a hotspot since the end of October — and the city’s schools have not been spared. “We know that with Omicron, we are going to be dealing with something even stronger,” Philippe says.

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Heading into the winter holidays, schools across Ontario handed out rapid antigen test kits to children. “Everyone wants to keep in person learning as ongoing as possible,” says Philippe. “Children's learning and their mental health is very much a priority. Having them immunized is very much a priority.” But, with rising case rates, “I think the mission is to get the Christmas break,” she says. “It’s really one day at a time.”

On December 17, while addressing reopening schools after the winter break, Premier Doug Ford said that “no decision has been made on what that looks like yet. We are simply not in the position to say that the situation is evolving too quickly to be able to know where we will be in early January.” A few days later, Ontario's medical officer of health, Kieran Moore, told reporters that, “I have consulted whether we should delay, and at present, with the experts that I've consulted, they don't see a reason to do that at present in Ontario.”

Some experts, such as Colin Furness, an infection-control epidemiologist and an assistant professor at the University of Toronto, believe schools will not be able to reopen after the winter break. TVO.org speaks with Furness about school cases, Omicron, and what parents can expect in the new year.

TVO.org: It can be difficult to know which global reports about Omicron we should listen to. What do we know about the variant?

Colin Furness: We know that it is just as contagious here as it was elsewhere. That's confirmatory. What's new is it's clear that two doses of vaccine do very little to protect you from getting infected, but they do have a significant reduction on hospitalization. So, it gets down to: how lucky do you feel? How healthy do you feel? Seventy-five per cent of people in Denmark are fully vaccinated, and 75 per cent of Omicron cases are among the vaccinated. So, in other words, [two-dose] vaccination does not reduce the proportion of people who are registering as infected.

TVO.org: Why have schools seen so many outbreaks?

Furness: It's grim. Transmission in schools has been higher than in the greater community. That's what we expected, particularly primary schools, because these are large, persistent gatherings. For quite a large number of them, especially with kids under 12, vaccination has just started. Kids have been the canary in the coal mine since September. We're opening up and opening up and opening up, and we were going to see the impact in schools. Well, the canary has been choking. It's incredibly unfortunate. And the consequences have been exactly what we would expect them to be, which is transmission. We shouldn't be surprised, but I think we should be incredibly dismayed that this is how we treat our children.

TVO.org: Rapid antigen testing has been made available to parents leading into the holiday. How effective will this be as a screening tool?

Furness: That’s actually of the one of the only smart things that I've seen the government do. It does feel a little bit like a day late and a dollar short, but it does have considerable value.

They're not poor cousins to PCR testing, which is the way they tend to get portrayed. They're a really effective — and you use exactly the right word — screening tool. They're not diagnostic; they will not tell you if you have COVID or not. They answer one screening question: are you contagious right now? And as a screening tool, that's enormously useful.

What you've got to communicate, and what people need to understand is: if you're gathering as a family over the holidays, to say that you gave your kids or anyone a rapid test the day before is pointless. You’ve got to do it at the start of the gathering and say, ‘we're going to all now answer the question. Is anyone here contagious right now?’ That's their use, that's their value. We don't have a better screening tool than that.

TVO.org: Based on the available modelling, and we understand that high community prevalence leads to more cases in schools, do you think it’s safe to open schools come January?

Furness: They can't open in January. There's no doubt in my mind at all. And I hate to be negative about this, but I just want to be realistic. The idea that you're going to send a class home if you find two cases in the same class assumes that we actually have functioning contact tracing. We don't. It's not possible with the number of cases we have. I don't mean to pick on local public health units, but the resources to do contact tracing just don't exist.

Now, the upside is that this is not a six-month problem. We can measure this problem in weeks, not months. Omicron is going to rip through here, it's going to make a lot of people sick. And then either through vaccination or infection, we will then stave it off and it'll disappear. It'll dissipate as quickly as it arrived. I can only guess at the timing at this point. But it's plausible that by February, Omicron is in the rearview mirror. It’s plausible that we'll actually get kids back into school by the beginning of February. But it's not happening in January, it can't.

TVO.org: But as it stands for the time being, schools are slated to reopen after the break. Do you have any suggestions for parents if that remains true?

Furness: If schools were to reopen and prevalence is still high, I would advise to resist.  I will not send my children back to school in person with high community prevalence. They will catch COVID. That's not okay. It's not acceptable to me, so that’s my plan. If the province is stupid enough to open schools when community prevalence is really high — and I really don't think they will — but if they were, my kids aren't going. Not until it's safe. The point in which it becomes safe is declining community prevalence: clear, declining community prevalence, and we're not going to see that in early January. It's going to be increasing, not decreasing. We need to see community prevalence on the decline before we talk about opening schools.

TVO.org: The province introduced its latest restrictions on December 17. Will this be effective in controlling the spread of Omicron?

Furness: I don't think that any decision made by the province so far changes the trajectory [of Omicron]. In other words: they're all doing all the right things, but not soon enough and not in great enough magnitude to make a significant difference. We should have ramped up third shots. We waited too long on that. Vaccination is going to be the most important tool we have, but the problem is we're not going to have vaccination in place until March because you need to get everybody done. And then you need to give enough time for the vaccine, for the immunity to build. So, we're going to miss this wave with vaccination.

Number two is to reduce capacity. But to reduce capacity to 50 per cent for things like restaurants and gatherings is to really demonstrate a lack of understanding of how communicable disease works. That's not going to make any difference. Or if it does, it will make the difference between catastrophic and highly disastrous. Fifty per cent [capacity in] restaurants is stupid. You're slightly reducing the chance that someone in the restaurant is carrying Omicron in the contagious form. But if someone is, everyone's going to get infected.

This all gets back to the fact that we're negotiating with coronavirus. We're saying: ‘Okay, we'll give you a few things. We'll empty some seats. Is that good enough, coronavirus?’ And you know, COVID doesn't work that way. You can't negotiate with it. It's extremely contagious. Politicians are sensing that people don't want lockdowns. Okay, fine, I get that. But they don't want to die of COVID, either. So, you've got to make some tough choices.

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

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