Class sizes vital to curbing spread of COVID-19 in schools, Sick Kids experts say

As Ontario’s back-to-school plans face increased scrutiny with thousands of parents calling for smaller elementary class sizes, leaders at the Hospital for Sick Children say that keeping classroom numbers low enough to enable physical distancing is key to curbing transmission of COVID-19 in schools.

Sick Kids President and CEO Dr. Ronald Cohn told the Star he will not back a plan that does not ensure proper physical distancing between students.

“If you have a certain number of children in a class … and physical distancing will be compromised by the number of children in the class, then we cannot and will not support this,” Cohn said.

Asked specifically about kindergarten classes with potentially 30 students in a single classroom, Dr. Upton Allen, head of infectious diseases at the hospital, said: “To me, personally, it seems like a lot. And I think that it’s certainly something that needs to be looked at.”

Both physicians said the province’s school plan, released on July 30, adopted “a majority” of the recommendations in a guidance document led by Sick Kids and co-authored by more than 30 public health and medical experts. But they emphasized the necessity of a multi-pronged approach to keeping schools safe, including, among other things, cleaning, masking and physical distancing. They said each measure is critical to the “bundled” response.

“Each compromise you make in the bundle is, by a certain degree, going to increase the risk, there is no doubt about it,” Cohn said. “If class sizes are not reduced, and that has an impact on other aspects of the bundle, that is a problem. And I would hope that through creative solutions we will be able to avoid that.”

Despite concerns over elementary class sizes, Cohn and Allen both said schools are the best places for kids come September, noting the risks of keeping children at home for the duration of the pandemic. They also expressed worry over a growing movement among some parents to create private learning “pods.”

Cohn said he believes the province “understands the complexity” of reopening schools during a pandemic. While Ontario’s current plan is the “most-comprehensive” in Canada, “we have to strive for the best possible implementation,” he said.

Sick Kids President and CEO Dr. Ronald Cohn told the Star he will not back a plan that does not ensure proper physical distancing between students.

Premier Doug Ford has called the provincial school plan for Ontario’s two million students the “best plan, bar none, across the country,” saying it was developed in consultation with “the best medical minds” in Canada. The Sick Kids-led guidance document states that “smaller class sizes should be a priority strategy as it will aid in physical distancing and reduce potential spread.”

The plan the government unveiled last week requires students from Grade 4 to 12 to wear masks, and caps high school classes in large urban boards at 15, but has drawn fire from parents, teachers and public health officials for retaining usual class sizes for elementary students.

At Queen’s Park on Friday, Ford and Education Minister Stephen Lecce again defended the plan, saying they had provided boards with resources to enable physical distancing, and were “working with” boards to find solutions.

“We’re giving the boards $ 30 million to hire new staff,” Ford said. “More staff equals smaller classrooms.”

Lecce added: “We’ve already provided guidance to school boards in the context of using the full footprint of their schools — their gymnasiums and cafeterias.”

“Ultimately, we’ve encouraged them to be innovative and look for solutions within the context of utilizing spaces in their schools and many of them are doing that as we speak,” he said.

Ford said on Friday that the plan is “all about flexibility” — a statement Allen said was encouraging.

“I would hope there may be some opportunities for further discussions,” Allen said.

Cohn said Sick Kids had not had a conversation with the province “in the last couple days.”

Dr. Upton Allen, head of infectious diseases at the Hospital for Sick Children, emphasized the necessity of a multi-pronged approach to keeping schools safe, including cleaning, masking and physical distancing.

When pressed about what is considered a safe number of elementary students in a class, Cohn and Allen would not provide a specific cut off, emphasizing that the size and orientation of individual classrooms would determine physical distancing needs.

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“This is where we need to listen to the school boards and the teachers,” Cohn said. “If they say, ‘If we don’t reduce class sizes, then we are also not able to maintain physical distancing and other things, and then I do think this needs to be revisited.”

In an email Friday, Toronto District School Board spokesperson Ryan Bird said the board is “working with the (education) ministry to explore options to lower elementary class sizes” but that the “limited funding” the government has provided for additional staff “is not enough to cover the requirements for a system our size, let alone the entire province.”

“As we explore these different options, it’s important to note that, depending on funding, other strategies may have to be considered, such as shortening the school day, reassigning teachers from non-classroom roles and lowering class sizes only in areas deemed at risk by Toronto Public Health,” Bird said.

Toronto Public Health expressed concerns this week over the board’s plan to retain full-size elementary classes — which, as Bird noted, was “prescribed by the ministry.”

Dr. Janine McCready, an infectious diseases physician at Michael Garron Hospital who reviewed the Sick Kids school document, said she was disappointed the Ministry of Education did not incorporate the recommendation for smaller class sizes at the elementary level.

“Smaller class sizes support physical distancing, which is really the most important intervention (inside a school),” she said. “With smaller cohorts of students, if there is an exposure, it’s a much smaller exposure … The more kids you are exposing, there is a higher risk of causing a broader outbreak.”

McCready said while there is no specific cut off for classroom numbers that makes a student cohort safe, smaller groups will help distance students from each other and aid teachers who need to monitor children for symptoms, hand washing and mask-wearing.

“If you put more kids in the class, you are making it higher risk that all those other mitigation strategies won’t line up and there will be a higher chance of exposure,” she said.

“Is 15 kids different than 16 kids? No. But is 15 kids different than 30 kids? Certainly.”

McCready said she hopes the government will listen to the experts and “take the feedback to heart.”

“I worry that if we go back with higher class sizes, especially in higher-risk communities, we may see spread within those classes faster. That will set us back and cause so much anxiety with communities and families.”

As of Friday, some 180,000 people had signed a petition urging the government to reduce class sizes.

Cohn, a pediatrician, acknowledges that anxiety levels are high among parents, but urged caution to those considering creating learning “pods,” which would bring children from several families together for home-schooling with a private tutor. He said “pods” require the same public health measures as schools, such as masking, enhanced cleaning and physical distancing, to be safe.

Cohn also emphasized the importance of keeping community transmission low for the reopening of schools to succeed, as well as keeping kids home “if they’re not 100 per cent.”

Megan Ogilvie
Rachel Mendleson

TORONTO STAR