As health authorities reassure that British Columbia’s schools are safe in the pandemic, a growing online community of parents share doubts and data. They question the criteria for defining a COVID-19 outbreak, debate science, and complain that what they hear from authorities is vague, outdated or flawed.
It’s a social media window into the public relations challenge faced by provincial health officer Dr. Bonnie Henry and others tasked with managing a second wave of COVID-19 spread.
Despite news reports of exposures at schools across B.C., local and provincial health authorities say COVID-19 transmission is not a risk for students, teachers and staff.
“Where we have COVID-19 circulating in our community, we will see cases in schools,” said Dr. Alexandra Choi, medical health officer with Vancouver Coastal Health, echoing a similar statement from Henry last month.
But Choi says the province has good safety plans for schools.
“And as a result, even though we have had children with COVID-19 in schools, because they’re picking it up from their families and their social contacts, we’ve had almost no transmissions in schools, even within the child’s class, even among the people that they see the most.”
While more than 200 schools in the Lower Mainland alone have experienced what health authorities are calling a COVID-19 “exposure” (where an infected individual is present in a school), there’s only been one official outbreak at a B.C. school so far.
But many parents are not satisfied with how health authorities classify these COVID-19 cases. They are crowdsourcing their own data. Notices of school exposures show up on sites like the BC School COVID Tracker Facebook page, hours or even days before they are posted on health authority sites, says Tracker founder Kathy Marliss.
“I think everyone has the right to know. They give you updates on exposures in a mall.... Why do we need to know [that]? I wasn’t necessarily at the mall,” said Marliss, who has a 15-year-old and an immunocompromised household member.
“We know because it allows us as a society to make decisions on how we may want to shop or where we may go out to eat. So why is that any different when it comes tied to school?”
While schools are supposed to notify staff and students of a COVID-19 exposure or cluster, which involves multiple infected people in one school, Marliss says she hears from school staff and teachers who say they trust her site over the health authorities’.
“Teachers are telling me that they have their own immunocompromised individuals in their households. And they’re using this as a resource to keep their family safe,” she said, adding she and her co-moderator for the page receive hundreds of emails daily and collectively work 11 hours on the page every day.
“Some of them didn’t even know there that there was a case in their school, and they weren’t even told by their administration or public health.”
How are some parents and B.C. health authorities so far apart when it comes to how safe schools are during the ongoing pandemic?
It has to do with transparency and the acceptable level of risk, says Jens von Bergmann, a parent and mathematician who crunches COVID-19 data.
“Exposures get posted fairly late. And the other part is that parents would like to have more information on the nature of the exposure: how does this case relate to the school? How many cases are there in the school? These are things that generally aren’t shared,” he said.
“One thing that I’ve noticed is that there is a certain difference in how parents feel about risk. And the precautionary principle and how that applies to their decision-making, compared to how the province does it.”
Exposures, clusters, outbreaks
The BC Centre for Disease Control has three categories for COVID-19 infections in schools: exposure, cluster and outbreak.
Exposure is when anyone who is actively infectious has been on school grounds and is at risk of infecting others.
A cluster is when multiple people in a school are infected with COVID-19 through interactions with one another inside or outside of school.
An outbreak is when uncontrolled, ongoing transmission of COVID-19 happens between students, faculty or staff at the school. So far only one official outbreak has been declared at a school, Ecole de l'Anse-au-sable in Kelowna.
What’s the difference between the 11 people infected at Ecole de l'Anse-au-sable, and the nine people infected at Caulfeild Elementary in West Vancouver, which was classified as a cluster?
Dr. Choi wouldn’t get into specific cases for privacy reasons, but said some transmission comes from tight social networks that interact outside as well as inside the school.
“The vast majority of transmissions have happened within households, and within social networks. We haven’t seen exposures to other kids who are in the school,” she said.
“And to be honest, the number of cases that we’ve seen as a result of schools’ transmission has been even lower than one would expect. So really, schools are not a high-risk environment, as we’ve seen so far in B.C. Even when there’s a child in school with COVID-19, the COVID-19 safety plans have been very effective in preventing transmissions.”
When any COVID-19 activity is linked to a school, whether it’s believed the infectious person visited the school or whether they caught it at school, the regional health authority works with infected individuals to find out where they were and who they were with while sick.
High-risk contacts are identified and contacted within a 24-hour period, said Choi.
“For anyone who’s lower risk, we would also be giving them a direct communication to self-monitor for any symptoms for 14 days. That might be an individual or an entire class or cohort,” she said.
“When a child is in school, typically they’ve only been around a small number of people, usually their class or their cohort. So those are generally the people exposed. It wouldn’t be the entire school who’s exposed.”
It is only after that 24-hour period that school administrators are permitted to notify the school community that an exposure has occurred. Then the school is added to the regional health authority’s online list of school exposures.
Dr. Choi added that if authorities have trouble contacting someone who may have been directly exposed, they may delay the release of the school letter by up to 24 hours until that person can be contacted. But those instances have been rare.
In the early days of back-to-school in September, Health Minister Adrian Dix said only outbreaks in schools would be made public.
However, health authorities — some faster than others — later began reporting exposures after parents expressed the need to know that information.
Choi says the decision was originally made because there is no risk to the wider public when an infected person is at a school. “Unlike with public exposures, there’s actually no public health action that’s required from school exposures.”
That’s why exposures in malls and stores are made public, Choi says: it may not be possible to contact every shopper exposed to the virus, and the best way to reach them is by going public.
However, schools know exactly who is in their building, she said.
“All the people who are exposed are directly contacted. So there actually is no action that needs to be taken as a result of the exposure being posted on the school website. And we have found that it actually leads to a lot of fear and anxiety and some bullying, as well, of the people who are involved.”
How the Facebook page works
Cindy Cheung’s two school-aged kids are learning from home this semester through the Richmond School District’s transitional learning program. But the kids will have to return to regular classes by February or — at least for her child in Grade 8 — risk losing their spot at school.
That, as well as interest in how COVID-19 is impacting the school community overall, has Cheung paying attention to the number of exposures in Richmond schools. Not on the Vancouver Coastal Health website, but on the grassroots BC School COVID Tracker Facebook page.
“We just find this much more comprehensive. And I mean, kudos to the parents who are running that page, they basically have been working all around the clock to provide updates whenever a parent provides the information,” Cheung said.
Cheung still trusts Dr. Henry, but says she’s frustrated by what appears to be a discrepancy or delay in posting exposures on the local and provincial health authorities’ websites, compared to the BC School COVID Tracker. She also takes issue with the health authority’s definition of exposures, clusters and outbreaks.
“Sometimes it’s very hard for me to find information on — now that there’s an increase in places — what are the percentages of people that are being affected?” said Cheung, adding she is most interested in the breakdown of infections by age groups.
“I can’t trust everything I see on the internet. But one of the places I do trust, and I know a lot of parents trust, is BC School COVID Tracker.”
Marliss launched the Facebook page on Sept. 22 after feeling frustrated that her daughter’s school in Vancouver was not planning to inform parents about every exposure.
“It was made very clear that it really wasn’t up to the school to inform families; it was really whether or not public health would allow the school to know, and even for the school to let their own faculty know. And that was a big red flag for me, just as a high-risk household,” she said.
Knowing the exposures allows parents to make informed decisions “day to day,” she says.
The BC School COVID Tracker relies on school community members — parents, teachers, staff or their families — confidentially sending Marliss and her co-moderator copies of the letters that schools send home to parents when there has been an exposure. They will only post an exposure if a school letter backs it up.
As of Nov. 2, BC School COVID Tracker had identified 364 school exposure events in 252 schools, with 65 of those schools experiencing multiple exposure events. Over 27,000 people follow the Facebook page, mainly from B.C., Marliss said.
“If there’s the case in a school, I think the school community as a whole should know. And then obviously more details can be given to say it was in this particular grade or cohort,” she said.
“And so, then you could say, ‘Okay, well, I may not be in that cohort, so I feel less risky,’ and I could choose to send my child back to school. Or if I’m feeling uneasy, I can say, ‘That’s fine. I’m going to stay home.’”
Asked why Vancouver Coastal Health doesn’t notify an entire school when an exposure event happens, Dr. Choi said there are not enough staff members to take on that task. But it also isn’t necessary.
“There is no risk of exposure in that circumstance,” she said, adding schools already notify the school community with their letters.
But Marliss contends that not everyone receives a letter when their school has been exposed, as she’s learned from emails sent to her by teachers and staff.
Public trust concerns
In addition to frustration over what he sees as a lack of transparency from health authorities regarding COVID-19 in schools, von Bergmann is baffled as to why neither the BC Centre for Disease Control nor Vancouver Coastal Health have recognized on their websites that airborne or “aerosol” transmission is a factor in how the disease is transmitted.
While the World Health Organization acknowledged airborne transmission back in July, the Public Health Agency of Canada didn’t update its COVID-19 guidelines to recognize airborne transmission until Nov. 4.
Asked why B.C. continues to ignore airborne transmission, a BC Centre for Disease Control spokesperson directed The Tyee to the Nov. 5 provincial pandemic briefing.
Dr. Henry did respond to a question about airborne transmission during the briefing, but without actually saying airborne transmission is happening or mentioning schools.
“There is a continuum of how people are exposed to this virus, and we get it from breathing in droplets that somebody has coughed out and those droplets can be of various sizes,” she said, citing cases in restaurants, bars, nightclubs, churches and weddings.
“So those are the scenarios where we can get broader spread to larger numbers of people, and those are the things that we’ve been taking the measures that we put in place to try and reduce those possibilities.”
Von Bergmann would like to see provincial schools follow COVID-19 guidelines like they have had in Taiwan and Germany, where airborne transmission is recognized.
“In German schools, every 20 minutes they open the windows, open the doors for three to five minutes. It’s a national directive to basically ventilate out every 20 minutes,” he said, adding this helps schools without proper air ventilation systems, as is the case for many B.C. schools.
“Taiwan, their rules are really simple. If there’s one case, the entire cohort goes home. If there are two cases the school gets closed. So it’s really simple that way: parents know exactly what’s going on, and they have mask wearing full-time at schools.”
Caroline Colijn, Canada 150 research chair in mathematics for evolution, infection and public health, also finds it troubling that health authorities ignore airborne transmission of COVID-19. She agrees they need to be more transparent regarding school exposures.
“We want to maintain that public trust and that can be helped with transparency about: what’s an outbreak? Why are we not calling an outbreak? Why are you hearing about this letter on social media days before Vancouver Coastal Health is reporting an exposure?” she said.
Although much of the information about the difference between exposure, cluster and outbreak, for example, is publicly available, Colijn said health authorities should make it easier on parents by discussing the issues in the government’s daily briefings.
“People are scared. And we went through this huge shut down.... People made huge sacrifices, they came at huge cost, and that was to prevent COVID,” she said.
“I think it undermines public trust now to say, ‘Oh, COVID, no big deal. Don’t worry if your child’s teacher might have COVID and we haven’t told you.’ I’m concerned that that will undermine public trust.”
Colijn is concerned about parents turning to Facebook to get their information, given the propensity for misinformation on social media.
As soon as school letters go out about exposures, she said health authorities should list the school on exposure lists. Colijn suggests modelling disclosures around COVID Écoles Quebec, a government-run site listing every school exposure in the province, versus the current system of posting to the regional health authority websites.
But overall, Colijn, who is also a math professor at Simon Fraser University, says the B.C. health authorities have been doing a good job of handling COVID-19 in schools.
In a preprint study, meaning it has yet to be peer reviewed, Colijn and her colleagues did simulations on which would be better for an exposure at a school: contact tracing of people who interacted with the infected person, or sending the entire class home.
If transmissibility remains low — meaning people are only getting COVID-19 from their close contacts who have shown symptoms— Colijn found when it comes to preventing infection spread within a classroom, there is little difference between isolating close contacts and sending the entire class home until tested.
“But of course, the whole class measure is way more disruptive, because you’re sending 25 to 30 people home to self-isolate, you’ve got all those families worried and disrupted. And it doesn’t actually make a huge difference,” she said.
Unless transmissibility goes up, like it has recently with the second wave of the pandemic in British Columbia.
“If you’re that unlucky to begin with, it doesn’t make enough difference,” she said. But so far, we have been lucky, Colijn says, because airborne infections within class cohorts have not been shown to be an issue yet.
If we can keep community infection rates down overall, we may continue on this trend until a vaccine is introduced.
If parents are concerned about how COVID-19 exposures, clusters and outbreaks in schools are disclosed to the school community, Colijn said they should contact their local health authority.
It’s a recommendation that Dr. Choi of Vancouver Coastal Health echoed.
“I would be interested in working with those parents more to better understand their information needs,” she said.