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Ontario Expands Asymptomatic COVID-19 Screening in Schools.  Here’s what you need to know

Ontario Expands Asymptomatic COVID-19 Screening in Schools. Here’s what you need to know

Asymptomatic tests for COVID-19 in schools increase across Ontario, following directive from Minister of Education Stephen Lecce earlier this month.

As part of an expansion of a pre-fall testing pilot, the province is requiring larger school boards to test at least five percent of their elementary and secondary students each week, with the goal of ” reach about two percent of the province’s student population. The campaign has started with schools in areas like Ottawa, Toronto, Peel and York in recent weeks.

We asked experts to explain what is behind this push, what is preventing families from testing, and how the new variants are factored into this initiative.

Why is this introduced?

Dr. Janine McCready of Michael Garron Hospital in Toronto was among the infectious disease physicians who worked with public health and education officials to conduct large-scale COVID-19 testing in schools that have experienced outbreaks last fall.

At a school in a hotspot area, the team found that between four and five percent of students without symptoms still tested positive for COVID-19, McCready said. This underscores the value of being proactive with asymptomatic testing, as another layer of protection against the coronavirus.

“We don’t want to wait until there are a certain number of cases in the school,” she said. “We really want to try to look for it and find it before it spreads through the classroom.”

She said the staff who run the in-person classes have done an “incredible” by implementing multiple layers of safety measures in the classrooms, “you would like to avoid as much as possible.”

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Screening clinics in Ottawa-area schools were held over several weekends in areas where health officials had previously seen clusters of cases. The goal was to identify people with COVID-19 – including those who may have withstood the test or who did not believe they were at risk – and break the chain of transmission, said Dr Nisha Thampi, medical director of infection prevention and control. at CHEO, a pediatric health and research center in Ottawa.

“What we’re trying to see is how to make testing more accessible, more acceptable, and easier to adopt as a way of being in the community.”

Which schools are selected?

Local health officials, school board representatives and public health units are teaming up to identify schools that will benefit the most from asymptomatic screening clinics.

Until now, that has meant schools in communities or areas with higher prevalence of COVID-19, McCready said.

Families hear about walk-in testing clinics in their neighborhood from a variety of locations: emails from principals, posts from community groups, and social media posts from school boards or local public health units.

However, in the future, the testing could potentially expand to other schools where more cases appear “and which require that extra level of protection.”

Who is tested?

Typically, the tests are available to students and staff at the particular school, but some jurisdictions have opened it up to parents and other family members as well. In some areas, testing is open to students and families from neighboring schools near the clinic location. The test is voluntary.

What tests are used?

Depending on the province, up to 50,000 tests per week could be performed as part of this push, using a combination of rapid antigen and polymerase chain reaction (PCR) testing. The collection methods used will vary by jurisdiction, and officials are testing different ways to make the collection process more acceptable to children.

Some might take a two-pronged approach, perhaps starting with administering rapid antigenic tests, with positive cases then being asked to return for PCR testing for confirmation.

For areas that start with a PCR test, that doesn’t necessarily mean that students will be greeted with the massive deep nasopharyngeal swab, used to take a sample from the back of the nose and throat. In McCready’s East Toronto area, for example, his team uses a shorter oral-nasal swab.

“A small tampon goes in your mouth, on the back of your tongue, on the inside of your cheek and right in front of your nose,” she says. “Most of the time, children can collect themselves, or it’s easy for a parent or the health care provider to do it for them.

“Then those tests would go back to our lab and then be processed in about 24 hours.”

Other teams are using saliva-collecting methods, while elsewhere in Canada some officials may be using gargles, Thampi said. The main thing is to make things easier.

“We recognize that test acceptability is so important, especially if we want to encourage people to get tested whenever they have been exposed to COVID-19. And it is much more acceptable to have less invasive collection methods.

Officials are exploring different methods of collecting specimens to make the COVID-19 test more acceptable to children. “The acceptability of the tests is so important … And it’s much more acceptable to have a less invasive method of collection,” says Dr. Nisha Thampi of CHEO, a pediatric health and research center in Ottawa. (Allison Dinner / Reuters)

What keeps families from getting tested?

There can be many reasons why parents might be inclined to clear symptoms and not have their children tested, from wanting to avoid further disruption at school to the financial ramifications of stopping work in quarantine, a noted Thampi, a pediatric doctor specializing in infectious diseases.

“Testing is of little value if individuals cannot follow the public health recommendation to self-isolate,” she said.

“We must be sensitive to the supports available for [families] when a test is done … Helping these people to be able to self-isolate with their homes is an essential part of the testing process. “

The fact that some families have to travel far to even reach an assessment center is another hurdle, she said, noting that there have been promising mobile clinics bringing the tests to the gates of more remote communities.

McCready has also heard directly from parents about the need to make testing much easier for families and reduce the stigma around it.

“A lot of people said, ‘The tests at school would make it easier for me … I wouldn’t have to take my three or four kids, organize them … in line’,” he said. she declared. “If you just did it in schools, it’s standardized, and everyone is doing it.”

How do the new variants take testing into account?

The different layers of measures schools use – from masking to physical distance to improving ventilation – still work against the worrying variants of COVID-19, but the increased transmissibility of these variants means “you have to be even better in all of these areas, ”says McCready.

“Variants give us a sense of urgency to improve the processes that have been in place or to think more creatively about how to make testing more accessible, acceptable and adopted in those communities where we are already seeing transmission,” Thampi said.

How will we know if it is working?

“It’s certainly not a one-size-fits-all process across the province,” said McCready. “50,000 [tests] it sounds like a huge number, and it’s very intimidating. But when you break it down and look at what each health unit, what each community, can do, and what they would like to do, then it becomes more manageable. “

She and Thampi said this push towards asymptomatic school testing will require careful deployment as well as ongoing assessment and adjustments to the process.

“We are able to look at how well the tests are going each week, what adjustments we can make,” Thampi said. She will look at community uptake of testing as a barometer of success.

“How many families of students have received this information? What is the participation in this community? … Are we able to bring families back if we call them with a positive rapid test? Are we able to break the chains transmission? ”

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