Embracing ‘natural immunity’ and sending children back to school is fraught with peril

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Top of mind for many pandemic-stressed parents is the question: When will children return to school and daycare?

Ontario said Sunday that it will be at least another month. Other provinces have simply avoided wading into that minefield.

But Quebec, which has by far the worst novel coronavirus outbreak in the country, has hinted that children will be back in the classroom soon.

Premier François Legault said the province needs to embrace the concept of “natural immunity.”

Before wading into the school question, let’s be clear about one thing. “Natural immunization is not a thing,” says James Kellner, a pediatrician and infectious-disease specialist at Alberta Children’s Hospital. “The term should not be used, because it implies that letting children be infected with coronavirus is benign, and it isn’t.”

This essentially is what Quebec is saying: It’s okay for children to get infected because they don’t get that sick from coronavirus. While that is true to a certain extent, it conveniently ignores the fact that children are cute, cuddly germ bombs – vectors for disease transmission.

And every child has adults in their lives, such as parents, grandparents, teachers, teacher aides, janitors and bus drivers.

Embracing “natural immunity” means you are fine with children spreading disease in the community and, by extension, having a significant number of adults infected so they, too, can develop “natural immunity.”

There will be a cost to that approach: lots of natural sickness and many natural deaths.

None of this suggests that children should remain out of school indefinitely.

“We absolutely need to get kids back to school, but we need to figure out how to do it safely,” Dr. Kellner says.

The Quebec Association of Pediatricians takes a similar view, saying “deconfinement of children is not only desirable but necessary.”

Being isolated has physical, mental and developmental consequences for children, especially for those who are disadvantaged. For example, 240,000 children in Quebec get breakfast at school each day; some of them may be going hungry, especially with so many parents out of work.

But sending children back to packed-to-the-rafters classrooms en masse has to be a non-starter.

The return – whether it begins next week or next month – has to be gradual.

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Both physical and temporal distancing need to be practised.

Physical distancing is a concept that we’re all familiar with now. In the school context, it means desks two metres apart, no large assemblies and restricted interactions at recess and during lunch breaks.

Temporal distancing is term that we’re going to learn as schools (and businesses) ramp up. It means staggering schedules. For example, half the children could go to school half the week, or half the day. It’s probably the only way we can maintain a semblance of physical distancing.

But negotiating scheduling changes with daycare centres, teachers’ unions and bus companies will be no small feat.

The advantage we have in Canada is that the pandemic took hold relatively late here, so we can learn lessons from countries in Europe and Asia.

Denmark reopened its schools almost two weeks ago, but only to children up to Grade 5, and groupings of more than two children at a time are not allowed, even in the schoolyard.

Countries such as Taiwan never closed schools at all, but have strict protocols around handwashing, physical distancing, mask-wearing and even regular temperature checks.

In the Canadian context, where there is no tradition of wearing masks, that is probably impractical. Temperature checks also provide false reassurance. Even in children who fall seriously ill and need to be admitted to hospital, only 58 per cent have a fever, according to a recent study out of New York. (And, yes, children can get ill; about 6 per cent of confirmed cases become critically ill.)

The big unknown is how many children contract the coronavirus and don’t have obvious symptoms and, just as importantly, how likely they are to infect others.

As with most everything coronavirus-related, there are more unknowns than knowns.

That’s true about the back-to-school debate as well.

As Dr. Kellner says: “There needs to be public discourse about the risks and benefits. But we can’t make these decisions based on dismissive comments like ‘kids don’t get sick.’ It’s way more complicated than that.”

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