Assessing the risk of in-person school in the age of COVID-19: A parent's perspective

Donald Lepp

Is it safe to send your children into the classroom in spite of the risks related to COVID-19?

That's the question many parents across Canada have been struggling with for the past year. As we endure a third wave, this question is as challenging as ever. For families like mine it's complicated by our need to manage complex health issues.

Both my wife and son have complex cardiac conditions, putting them at higher risk for complications from COVID-19. Living with medical issues, we've developed a strong network of medical professionals who've cared for us over the years. Many of these people feel like a second family, trusted friends. These relationships have had a huge impact on how we approach COVID risks.

In February of 2020, we didn’t know a lot about the virus and when we asked questions we got the information available at the time—which wasn’t a lot. We began to discuss potential risks with our medical team and what would happen if a positive case were to arrive in Manitoba. This prompted a thoughtful discussion with our doctors about practical ways to keep our high risk family members safe.

With many of the risks still unknown, our plan was fairly simple. As soon as there was a positive case in our Winnipeg community, we were going to self-isolate immediately. Our kids wouldn't go to school and I'd work from home. We required no public order or government declaration.

To a casual observer that might seem a little over the top. But self-isolating wasn't new to us as it was for so many Canadians. My son is a heart transplant recipient—a transplant received when he was five-months-old. As a transplant patient he needs to be on anti-rejection meds that suppress his immune system.

Inevitably, COVID did come to Manitoba. And as planned, we self-isolated. A few days later, the province issued an emergency order and schools closed in late March, 2020. That effectively ended the school year for our two children as there was limited in-person programming for the balance of the school year.

That summer, cases in our province were low and many restrictions were relaxed. However, the decision about school attendance in the fall loomed for our family. All indications were that schools would open but with protocols in place to reduce risk, using several months of new data to better assess how much risk we were willing to accept. We certainly took information from our public health officials into account, but our primary source for relevant information came from our own medical team. It was essential to have their input to consider our specific and extensive health needs—so extensive that we obtained the expertise of two children’s hospitals: the Health Sciences Centre (Children’s) in Winnipeg and the Stollery Children’s Hospital in Edmonton where my son had his heart transplant.

With the input from both hospitals and consults with experts in immunology and infectious diseases, we sent both of our children back to school and haven’t looked back. Although we were skeptical at first, our schools have done a tremendous job of managing risk. Both of our kids’ schools have had positive cases. In each instance the individual who tested positive got COVID in the community and no further spread occurred in the schools: a credit to the rigorous contact tracing and quick action when a case did materialize. After several instances, we gained confidence in our schools' ability to handle these situations. It’s been tremendously successful up to this point. But that doesn't mean that we won't have an outbreak in the future, so we remain vigilant.

So, what have we learned?

Our story is atypical. Most families don't have a paediatric cardiologist on speed dial. That level of access has created considerable trust, translating into a significant reduction in our anxiety. When we have questions, we don’t go to the internet, or social media. We go to the people we trust: our doctors. We could never do that if we didn’t have level of access we do.

A reliable source of information for most of the public seems sadly lacking. The level of support we're fortunate to have isn't the norm and impractical to provide on a large scale. However, the point I want to make is how critically important it is for our population to be able to have access to a medical professional they trust. It saddens me that so many in our country do not have a trusted family doctor whom they can access readily and in through their preferred avenue.

Trust is such an important issue to any medical system. Frequently, we see patients look to Google or Facebook as a primary source, rather than talking to a family doctor (assuming they have one). Effective communication has long been a deficiency in the healthcare system. It's not surprising more and more individuals are seeking alternative sources of information.

One only has to consider the rise of the multi-billion dollar alt-med industry and the politically powerful anti-vax movement to realize our highly trained medical professionals have a significant credibility problem. Couple this with social media and you have a perfect storm of misinformation. Fear drives these movements and the only way to alleviate fear is honesty, humility and accurate information. Too many medical social media stars have chosen demeaning language, snark and medical snobbery to respond. I know these comments are great for clicks and likes, but all they do is entrench the opposing view. Healthy debate seems to be effectively dead.

Where does that leave the average citizen?

Unfortunately, mixed messages, contradictions and selective data remain all too prevalent have left the Canadian public as confused as when they first heard of COVID-19. It explains why many would be surprised that a family like mine is willing to take the risk of sending their children to school. For many families like mine who have children who are complex medically or have special needs these are very difficult decisions. Making trusted information critical in making an informed decision.

Is there risk in what we are doing? Definitely. But we've obtained the best information available, to make the most qualified decision regarding the health of our children.

In considering our decision, I always return to sage advice we received from one of our transplant cardiologists not long after our son’s transplant. He explained many precautions we would have to take to keep our son safe given his compromised immune system. Some of the advice was practical and some wasn't—after all we were dealing with a tiny baby who in all likelihood would literally eat dirt—the doctor eventually relented and acknowledged that we couldn’t eliminate every risk. In essence, if you make the decision to allocate extensive resources and use thousands of hours of care as we have, all to save the life of one child, don’t you owe that same child . . . a life?

That’s my concern about closing schools and the demonstrable harm of eliminating in-school instruction—we are in effect keeping them safe but taking away their “life.”

Donald Lepp is a patient advocate and author of the book Heart Broken which chronicles his family's journey through the health care system.