Matt Strauss: Schools will be safer for children than the cars that get them there

The risk posed to school-aged children by COVID-19 is extraordinarily low. We need to base our re-opening plans on rational risk assessments. Not panic.

By: Matt Strauss

The Canadian public is fit to be tied over plans to open schools in September. The prime minister himself is unsure whether he will send his children back. This is madness. I am not a parent, but as an ICU physician, I can confidently state that the risk to children is so low as to be negligible. We currently accept far greater health risks to children without much public concern.

For perspective, every year in Canada, 150 children are killed by motor vehicles. So far in the pandemic, one child with COVID-19 has died. Even then, according to reports, the child died with the infection, not because of it. 

I know the objection to such figures will be that Canadian COVID-19 mortality in children is low because of the stringent measures taken to date, including shutting down schools. 

This objection does not stand up to analysis.

There are eight million Canadians under age nineteen. Of them, 10,039 have tested positive for COVID-19 by the PCR test — which detects bits of the virus in the nasal passages. If we had confidence that every child infected with COVID-19 in Canada was tested and identified, we could say that the mortality rate appears to be one in 10,000. However, we cannot have this confidence, and so even that low probability is likely an overestimate of the actual risk.

Early in the pandemic, Canadians who thought they might have COVID-19 were instructed to stay home and not seek testing unless they became short of breath. As the WHO estimates that 80 per cent of COVID-19 infections are mild or asymptomatic, it's reasonable to surmise that many, many cases in children have gone undocumented.

Antibody tests, also known as serologic tests, look for evidence that a person has mounted an immune response to COVID-19. They identify people who have recovered and no longer have viral elements in their system. This can help us to find those undocumented cases and thereby improve our mortality estimate.

So far, Belgium appears to be the hardest-hit country in the world in terms of COVID-19 deaths per capita. Researchers at the University of Antwerp have published an antibody study (still in preprint) suggesting that 10 per cent of the 2.3 million Belgians under age 19 have recovered from COVID-19 infection. Yet, the Belgian institute for health, Sciensano, currently reports only three COVID-19 deaths in persons under 19. These figures yield a mortality risk for infected children of one in 70,000.

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Two weeks ago, in Ontario, a three-year-old boy in Etobicoke was killed by a motor vehicle, and a one-year-old boy was killed by a courier van in Mississauga. In July, an eight-year-old was killed in an accident involving an impaired driver in London, Ontario and another eight-year-old was killed while crossing the street in Montréal. In Brampton this June, three sisters ages six, four and one were killed in a collision involving a young man with previous driving convictions. This carnage is tragic, senseless and unconscionable. It far outpaces any danger COVID-19 poses to Canadian children.

To put it another way, we might say that a child faces a higher probability of being killed by a car on the way to school than dying by COVID-19 acquired once he or she gets there. 

In this light, our actions make no sense. Why do we all engage in a daily activity (driving a car) that kills more kids than COVID-19? You might claim that COVID-19 deaths are preventable while car deaths are not. But this isn’t true. Multiple studies have shown that lower speed limits, speed cameras, separated bike lanes, etc., all reduce traffic deaths at low cost. Conversely, the psychological and economic costs of depriving children of their education can neither be calculated nor countenanced.

Of course, I understand that while children themselves might not be threatened by COVID-19 at school, there are risks to others that need to be considered. Teachers and school staff will be exposed. Children could bring COVID-19 home and infect a vulnerable parent or grandparent. These are risks, but they can can be mitigated. Global serology studies suggest that adults under 44 years of age who catch COVID-19 are still more likely to die in a car accident this year. Elders are the major concern but we must bear in mind that only six per cent of Canadian homes are multigenerational. Great effort to protect the vulnerable must be undertaken. Depriving the nation’s children of their education is not the best way to go about it. 

Emotions run hot where the safety of children is at play, I get it. But the simple fact is that the safety of children is not actually at play here, relative to other routine, uncontroversial activities. Once we acknowledge that, we can start to make reasonable decisions to secure their future. 

Matt Strauss is a critical care and internal medicine specialist who practices in Ontario.

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