Opinion: Lack of pandemic preparedness led to a perfect storm in Quebec elementary schools

A grade six class room is shown at Hunter's Glen Junior Public School which is part of the Toronto District School Board (TDSB) during the COVID-19 pandemic in Toronto, Monday, Sept. 14, 2020. THE CANADIAN PRESS/Nathan Denette

With the emergence of Omicron resulting in cases rising astronomically and the prospect of a major breakdown in the health care system, questions must be raised about the level of pandemic preparedness in Quebec.

Throughout this pandemic, schools have acted like the proverbial canary in the COVID-19 coal mine. It is now widely acknowledged that schools have been a major factor in amplifying COVID-19 transmission in the community. During the second and third waves, the Quebec government shrugged off the warnings of hundreds of experts and scientists that government measures were inadequate to prevent the spread of the virus in schools. Mr. Legault, his ministers and public health "experts" ignored and even denied the pile of scientific evidence showing that COVID-19 can be transmitted by aerosols in poorly ventilated classrooms and that transmission can occur over large distances. The English Montreal School Board and the Lester B. Pearson School Board took it upon themselves to install HEPA air purifiers in classrooms, although regrettably, the government did not allow French-language schools to follow suit.

As early as October, when Delta dominated the fourth wave, data from the Montreal Public Health Department began to paint a disturbing picture that the number of outbreaks was rising rapidly and disproportionately in elementary schools, where children were not fully vaccinated. The warning signs were ignored by the government and public health officials and until recently largely unreported in the media.

In the seven-day period ending Dec. 14 coinciding with the last day of school, the number of outbreaks reported in Montreal elementary schools was the highest of all sectors. Over 155 elementary school outbreaks were reported, resulting in 552 cases. By comparison, only seven outbreaks occurred in high schools during that same period totalling only 20 cases and most surprisingly, only a single outbreak was reported in Montreal hospitals, resulting in barely two cases and one outbreak in a CHSLD with three related cases. To put it another way, elementary school outbreaks resulted in 22 times the number of cases in high schools, hospitals and CHSLD combined.

Bottom line, despite the use of preventive practices such as mask-wearing, which has been mandatory in all Montreal schools since the beginning of the school year, inadequate ventilation combined with a lack of vaccination in elementary schools constituted the basic ingredients for a perfect pandemic storm. There is no doubt that transmission in schools spread to the community worsening the fallout from the pandemic.

Also, a comparison between Ontario and Quebec data shows that, based on the seven-day average ending Dec. 28, Quebec had 3.9 times as many cases per capita as Ontario, further evidence of Quebec's mismanagement of the pandemic.

The Ontario government announced last summer it was investing $600 million in school ventilation, to ensure that all occupied classrooms, gyms, libraries and other instructional spaces without mechanical ventilation have standalone high-efficiency particulate air (HEPA) filter units in place when students return to class. By contrast, Quebec's underwhelming solution is to measure air quality using carbon dioxide (CO2) captors in 90,000 classrooms at a cost of 78 million, a program that has hardly begun and is moving at a snail's pace while delaying crucial decisions to install air exchangers. Indoor CO2 measurement offers an imprecise estimate of viral transmission by measuring exhaled carbon dioxide. This method, while valuable in some indoor settings, cannot replace by any means effective measures to reduce transmission risks such as installing air exchangers or purifiers, especially in the light of the epidemiological data which Quebec collected last spring from 15,000 classrooms showing that almost half of them had levels above 1,000 ppm, a level associated with a higher risk of airborne transmission.

With the highly contagious Omicron breaking records and Delta still not done with us, it is alarming that children, the vast majority of which are not fully vaccinated, will be returning to schools in January in the same unsanitary, poorly ventilated classrooms that likely contributed to the widespread COVID-19 outbreaks. It should come as no surprise if COVID-19 will come there again to roost.

Equally chilling is the recent government directive that infected children and staff can return to daycare centres without testing. In a stunning development, the Montreal Public Health Department elected to suspend the order because it disagreed with the province’s assessment. This unprecedented decision to break rank highlights a lack of confidence from local authorities in the government's decisions.

Quebec had two years to address the ventilation issue which is plaguing our school and other establishments such as CHLSDs, daycares, and gyms, yet mostly ignored it. It was not prepared for the latest waves nor is it currently prepared to deal with potential future variants or future pandemics.

Are Mr. Legault and his salaried public health bureaucrats asleep at the wheel?

- Michael Levy, MPH is an environmental health specialist and epidemiologist