As the Omicron variant spreads through the population at large, it is urgent that we do everything we possibly can to ensure all members of society are protected as much is currently possible. We are now in a situation we couldn’t have imagined at the start of this pandemic—we have access to PCR testing, rapid antigen testing, filtration technologies, and effective vaccines. These are the tools in our toolbox that we need to draw upon right now to protect the most vulnerable among us, to keep parents in the workforce, and to ensure we don’t overwhelm our already flagging healthcare system. The following are the steps that we would like to see implemented prior to a return to in-school learning: 

1. Prioritized boosters for teachers and in-school support staff
2. Online learning options for all students
3. Bookings open for second vaccine doses for all children 5–11 years of age who received their first dose at least 3 weeks prior (in accordance with the Health Canada-approved schedule)
4. In addition to 3-layer masks, N95 masks and face shields offered to all students, teachers, and in-school support staff (with adequate instruction on maintaining good fit)
5. HEPA filtration systems in all classrooms that lack adequate mechanical ventilation 
6. Contact tracing support for all schools or a system for rapid notification of all close contacts
7. Pop-up PCR testing (including asymptomatic screening) of school communities with rising case counts

Summarized below are some key points that should be considered when allocating pandemic-related resources.

Protecting vulnerable community members: Ensuring we limit spread in schools is critical for keeping other vulnerable community members safe. These are the siblings of school-aged children who are under 5 who have no vaccine options right now; the grandparents with age-related immune system decline and underlying conditions who, even with a booster, are at risk of serious infection-related complications; the classmates with asthma, cancer, kidney disease, diabetes, cystic fibrosis, Down syndrome, immune deficiency disorders, Sickle Cell Disease, and those who have undergone transplantation. We have a responsibility to protect everyone to the best of our current ability.

Keeping parents in the workforce with online learning support: Anecdotally, recurrent school closures and close contact notifications wreak absolute havoc on parents and their employers. Parents struggle to meet the demands of work while ensuring their children don’t fall behind in school. Employers can’t meet the demands of clients, customers, etc, while their workforce focuses on more pressing needs at home. It is an impossible situation for everyone involved. Online learning options are an absolute need-to-have to ensure no student is left behind and that parents have the support required to continue their participation in the workforce. This hybrid model could be used at parental discretion for students at higher personal risk, students with caregivers at higher personal risk, students who are isolating due to illness (COVID or non-COVID–related), and classroom closures due to COVID spread.   

Mitigating risk of viral mutation: Schools will be the largest pool of people who are unvaccinated or under-vaccinated. Not only does this pose a substantial risk to the wider population by way of driving community spread but it also has the potential to drive variant evolution. Despite everyone’s best efforts to cohort the children and have them wear masks consistently and properly, low vaccine coverage in this population can drive viral mutation.

Minimizing risks to children through full vaccination coverage: While children tend to have asymptomatic or mild infections, there are those who do not fare so well. Pediatric hospitalizations in the US were up 48% from December 21–28. Dr. Stanley Spinner, chief medical officer and vice president at Texas Children’s Pediatrics & Urgent Care in Houston, noted that “most of the really sick children are unvaccinated or under-vaccinated…virtually all of [the] kids that are hospitalized have either been unvaccinated or not fully vaccinated—maybe having received one dose but not having the second dose and not having the full protection from the vaccine.” Children can also suffer from late complications like MIS-C or long COVID. We should not be complacent about the risks to the pediatric population just because *most* of them experience mild disease. 

With the first pediatric doses administered in NS in early December, not a single child under 12 years of age will be fully vaccinated upon return to school. Those vaccinated at the earliest time points will only be eligible for their second dose in late January and will not benefit from full immunization until mid-February. Many NS children could be receiving their second dose now, with maximum protection by mid-January. 

Instead, our children will return to congested classrooms where they will remove masks at lunch time. They will fiddle with masks, lose them, and struggle to keep them on consistently. Those without glasses or face shields will run the risk of contracting COVID through the ocular mucosa (a recognized, albeit under appreciated, mode of transmission). And all of this will be happening in a population of people who are unvaccinated or under-vaccinated.

In Ontario, parents are able to opt (with informed consent) for their children to receive their second vaccine dose according the Health Canada-approved dosing schedule (ie, 3 weeks after their first vaccine). NS parents are unable to make this choice for their children as we are blocked by the booking system from booking any earlier than the 8 weeks recommended by NACI. The current NACI guidance is based on adult real-world evidence, rather than clear data in the pediatric population. Following it now is a luxury we cannot afford in the face of this highly infectious variant. To paraphrase Dr. Strang: NS needs to base decision-making on the current epidemiology in the province. This tactic has served us well throughout the pandemic and should not be abandoned now. 

The clinical trial data supported a 3-week dosing interval and millions of children have been vaccinated according to this schedule. Parents in other provinces are able to make an informed choice for their children and opt for the Health Canada-approved 3-week interval. NS parents must be afforded the same right.

Opening up bookings for pediatric second doses in accordance with the Health Canada-approved schedule, in alignment with other provinces, would add another essential layer of protection for our kids, the vulnerable people in our families, and the wider community.