MONTREAL -- Albert Einstein was quoted as saying that the definition of insanity is doing the same thing over and over and expecting different results.

The dramatic rise in COVID-19 in children following the school reopening last fall should be a wake-up call for government officials that the measures failed to prevent the spread of COVID-19 in schools, even during red alert. 

Quebec legislators did not heed the warnings of 150 doctors and scientists that the rules were too lax to prevent transmission of COVID-19 in the school setting and to the community at large. 

The skyrocketing cases among schoolchildren that followed the reopening were, according to experts, a driving force behind the surge in the general population. 

The weekly COVID-19 case numbers published by the Montreal public health department tell the story. 

By the end of the school session in December, there were more outbreaks in Montreal schools than in any other sectors, including the workforce or the health sector. 

During that period, Montreal elementary schools alone had 96 outbreaks compared to 91 outbreaks in the workplace. 

Thirty-eight per cent of all the outbreaks in Montreal occurred in schools and an additional 12 per cent in daycare, making up half of all the outbreaks in Montreal. 

Many school outbreaks were major. In the first week of December, eight outbreaks were recorded in Montreal schools, each with 20 and over active cases per school. 

According to the Quebec Public Health Institute (INSPQ), which compiles the data, these outbreaks cannot be explained epidemiologically by contacts outside the school setting. 

More evidence that Quebec schools are a major catalyst of transmission comes from comparisons with data from other provinces. 

For example, following the closing of schools in mid-December for the holiday season, Quebec recorded 4227 positive cases in the previous 14 days compared to 1533 in Ontario during that same period. 

Adjusting for Ontario's larger population (14.7 million vs 8.6 million in Quebec), this means that Quebec had FIVE TIMES more active school cases than Ontario, and that does not include Grade 12 students included in the Ontario school case count. 

So what explains these findings? The main difference is that Quebec failed to comply with Health Canada COVID guidelines to the extent that other provinces did. 

One of the key recommendations from Health Canada, not surprisingly, is that all children 10 and over must wear masks, and that this simple measure should be extended to all schoolchildren when other risk factors cannot be controlled and case counts are extremely high as is the case in Quebec. 

Incomprehensibly, Quebec elementary schoolchildren are still not required to wear a mask in classrooms, which are overcrowded and poorly ventilated, all conditions which create a perfect breeding ground for respiratory viruses such as the novel coronavirus. 

Health Canada recommends smaller classroom sizes, two-metre physical distancing in most settings, improved ventilation, enhanced distance learning, etc. These are all factors desperately lacking in the Quebec school system.

Last fall's school reopening in Quebec was bungled and the disastrous outcome was predictable. 

We cannot afford to make that same mistakes again. 

The latest case numbers in late December are extremely worrying; schools should not reopen when the numbers are so high. 

The reopening plan should first and foremost be based on getting the numbers under control rather than setting a fixed date and it is extremely doubtful that this will happen by Jan. 11. 

Despite the arrival of an effective vaccine, the pandemic is far from over and unfortunately, we must expect thousands more deaths in Quebec. 

Rapid testing should now be considered a first line of defence against COVID 19. It is an essential public health screening tool that should be used extensively in the school setting, on a daily basis if necessary. 

Quebec must act more diligently in accordance with Health Canada guidelines, imposing stricter school measures and allowing much greater access to distance learning. Failure to do so will very quickly result in cases spiraling out of control to the same levels we have today and unfortunately lead to more needless deaths.

- Michael Levy, MPH (Master's in Public Health), is an environmental health specialist and epidemiologist