Opinion: Public health doctors must be held accountable for reopening schools with unsafe ventilation, says group of health experts, scientists
As Yogi Berra the legendary baseball catcher put it, “it's déjà vu all over again”.
Quebec's decision to reopen schools on Jan. 17 has many experts and parents shaking their heads in disbelief. It defies scientific logic as COVID-19 hospital, ICU admissions and deaths have hit record highs, while critical issues such as school ventilation and effective masking strategies are neglected or belittled.
This coincided incongruously with Health Minister Christian Dubé telling us “We are almost at the point of no return”, that the stage 4 "délestage" may no longer be enough and that we should see more critical surgeries cancelled, something unthinkable just a few weeks ago.
To make matters worse, the situation in Quebec hospitals is now the most critical than in all G7 countries.
Most agree that kids need to go to school, but schools must be foremost safe and sanitary.
Children do not live in isolation. If they get sick, they may well transmit the virus to other family members, to the community and eventually to the most vulnerable.
What Quebec Premier François Legault proposes falls far short of the Ontario plan to go full out with the widespread installation of air purifiers/exchangers in every classroom, every school cafeteria, and every gym as well as providing N-95 masks to teachers among other protective measures.
The Legault government justified its inaction through the inaccurate pretenses that there "is no problem with school ventilation", that "SARS-Cov-2 is transmitted only marginally via aerosols", that "there is no significant transmission from schools to the community", that "rapid tests were too unreliable."
The real problem is that similar fallacious arguments are still being used by Quebec leaders and public health officials today as they were since the beginning of the pandemic despite all scientific evidence to the contrary.
What is particularly galling is the persistent infantilization of the population by using simplistic and specious statements unsupported by scientific data, coupled with a paternalistic attitude toward the "inept" masses.
Having to fend for themselves, some school boards felt compelled to purchase air purifiers as a stop-gap measure. Caught off guard, Quebec public health officials falsely claimed that air purifiers "could be dangerous" if the devices were improperly installed or maintained.
Contrary to the claims from Quebec’s ministry of health experts that HEPA portable air purifiers have not been demonstrated effective to prevent airborne disease transmission, the United States Centers for Disease Control and Prevention (CDC) recommends their use, especially in high-risk areas, as does the Canadian Public Health Agency.
Quebec's answer is that air exchangers are better than air purifiers since they remove stale air and replace it with outside air which is true in many situations, but they are more costly and complex to install, whereas air purifiers can be installed professionally the same day.
However, effective risk mitigation strategies especially in times of imminent danger require immediate action.
So, why did Quebec not offer the air exchanger option last year to all school boards? Why were English-language school boards left out on their own to purchase air purifiers and denied any public health guidance? How are the $432 million in federal money bestowed to improve school air quality being used?
Belatedly, Quebec is now distributing carbon dioxide (CO2) readers to 70 per cent of schools. Such monitors can indicate when opening windows (an unrealistic option on cold winter days) or evacuating a room is indicated to reduce the risk of airborne SARS-Cov-2 transmission, but they do not prevent the underlying cause of viral transmission as they do not purify nor refresh the air in a room.
The best anti-COVID strategy is to invest massively in air exchangers and air cleaners. Currently, only 500 air exchangers are available for the whole province, a drop in the ocean of 48,000 classrooms.
After decades of neglect, Quebec’s inadequate school ventilation systems are a major health issue in the present pandemic.
We cannot wait years for the direly needed repairs. To blunt the COVID-19 pandemic, air exchangers and HEPA ventilators are the required short-term solution. Quebec knows that a majority of schools are not complying with the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) air filtration/exchange standards for schools to reduce airborne SARS-Cov-2.
Recently, media outlets reported on the loss of confidence toward Dr. Horacio Arruda, alleging he lacked autonomy from his political leaders and merely served as a cover for them. The arrival of Dr. Luc Boileau as the new interim public health director signified a potential hope for science-driven policies.
Unfortunately, his first decision on the job was to give the green light to reopen the schools on Jan. 17.
Boileau repeated the same trope that flies in the face of scientific consensus, that “there is no evidence that schools amplify COVID-19 transmission to the community,” sweeping aside international and Canadian studies which say otherwise. He dismissed Quebec's own data, which showed a disproportionate increase in outbreaks in elementary schools from September to December 2021. Only very recently, on Jan. 19, did he reluctantly understate that opening schools may induce "a little bit" more transmission.
Dr. Boileau is already giving us an uneasy feeling of déjà vu.
As Quebec's leaders and public health officials depart blatantly from science and precautionary principles, an increasingly skeptical media has been reaching out to doctors and scientists working in the health field and in academia to obtain more reliable and trustworthy information.
We do not hold the same high expectations from politicians as we do for doctors working in the public health field. These medical professionals hold enormous responsibilities, and their conduct must be exemplary.
Public health doctors must be held accountable to the same quality and ethical standards as those working in the clinical field who can face severe consequences should they fail in their duty to provide quality care to their patients according to the best available medical standards.
Never has this been so true as it is now.
Michael Levy, M.P.H. (Master’s in Public Health), environmental health specialist and epidemiologist
Michel Camus, Ph.D., environmental health epidemiologist (retired)
Nancy Delagrave, physicist, scientific coordinator of Covid-Stop
Stéphane Bilodeau, eng., Ph.D., FIC, Indoor Air Quality Task Force Coordinator, World Health Network
Nimâ Machouf, Ph.D., epidemiologist, consultant in infectious diseases, lecturer at Université de Montréal’s School of Public Health
Pierre-Jules Tremblay, eng.
Donald Vinh, M.D., infectious disease specialist and medical microbiologist
Marie Jobin, PhD, organisational psychology
Steeve Tremblay, occupational health and safety consultant