In-person learning promotes the well-being of children by providing opportunities for academic learning, physical activity, and positive social relationships with peers. In-person learning also often contributes to children’s nutrition, health and security. Current evidence suggests that school closures and the elimination of extracurricular activities as a result of the COVID-19 pandemic has resulted in deteriorating mental and physical health among children. Therefore, return to in-person learning and extracurricular activities should be prioritized in the upcoming year. School closures and remote learning should not be used as a pandemic control measure unless there are signals that in-person learning is causing harm (morbidity/mortality) to children or the community at large. Instead, community-based health measures, such as the closure of non-essential workplaces, indoor capacity restrictions, masking and contact tracing, should be the preferred methods of pandemic control.

The majority of COVID-19 infections in children and youth continue to be associated with asymptomatic or mild disease. Acute infection requiring intensive care has been described in a small minority of pediatric cases (0.06% of confirmed COVID-19 cases in children under 19 years of age), particularly among children with underlying medical conditions. However, even in these patients, the clinical course of infection is much less severe than in adults, and deaths are extremely rare.

Several control measures will be effective for reducing the risk of transmission in schools, including staying home when sick, hand-washing, wearing a well-fitted mask, physical distancing, and maintaining adequate indoor air quality through ventilation and filtration. In addition, immunization is the most effective way to reduce COVID-19 transmission in schools, and widespread uptake of the COVID-19 vaccine will reduce infection rates even among unvaccinated children. Outbreaks in schools remain a possibility among unvaccinated children or if COVID-19 variants resistant to the vaccine become predominant. As schools reopen, there must be mechanisms in place at local, regional and provincial levels to monitor changes in the acute and chronic impacts of COVID-19 in children and youth, and to monitor the impacts of loosening restrictions in school and non-school settings on COVID-19 transmission.

Recommended measures to control the risk of transmission in schools include:

• Vaccination of eligible students and staff
• Staying home when sick
• Maintaining indoor air quality by upgrading school ventilation, heating and cooling systems
• Appropriate environmental cleaning
• Symptom and exposure screening
• Diagnostic testing
• Use of non-medical or medical masks
• Physical distancing
• Optimizing ventilation/filtration in classrooms, and increased use of outdoor space (when possible)

Rural, remote and Indigenous communities have additional challenges for education delivery. It is important to note that the success of public health programs in preventing transmission of COVID-19 in these communities relies on close collaboration between local leadership and public health units.

Here are some important considerations for rural, remote, and Indigenous communities:

• Transportation considerations will be different for children in rural, remote and First Nations communities because they may be in transit for prolonged time periods to and from school
• Given the close-knit, multi-generational communities, it will be important that public health resources are available to strengthen testing and contact tracing. In addition, Indigenous contact tracers should be leveraged where applicable to ensure culturally safe care
• Ensure culturally appropriate messaging for Indigenous populations that takes into consideration historical factors contributing to vaccine hesitancy and medical mistrust; include Elders and Knowledge Keepers in vaccine distribution and promotion plans.
• Aging infrastructure, including older HVAC and supplemental ventilation/filtration systems in many remote First Nations, Métis, and Inuit communities may impact the ability to properly ventilate schools and ensure adequate air quality
• Overcrowded education infrastructure in some remote First Nations, Métis, and Inuit communities could make preventative measures such as cohorting and physical distancing difficult and could result in the need to shift to remote learning in some instances; appropriate resources should be provided to ensure adequate space is available to support consistent in-person learning in these communities, and to ensure equitable access to digital learning resources.

Return to school must be inclusive of children who depend on schools for therapies, and those who require intensive supports for activities of daily living, such as feeding, positioning, toileting or breathing supports. Consultation with parents to understand needs of each child is recommended. Moreover, high vaccine uptake among this vulnerable group, and those that come into contact with them is important.

As COVID-19 vaccination is the single most effective way to reduce transmission of the virus in schools, eligible individuals, including parents, school staff and students, should be encouraged to receive the vaccine. Vaccine distribution plans should prioritize ease of access, such as offering vaccination clinics on school sites for parents, staff and children. Vaccination campaigns to reduce vaccine hesitancy are important, especially among COVID-19 hotspot neighbourhoods.

Recommendations for reporting vaccination status:

• Vaccination status for staff and students should be reported to school and public health authorities at the start of the school year and updated regularly to inform public health efforts
• It is essential to maintain the confidentiality and anonymity of vaccination data. Schools and school boards should only have access to aggregated data, and individual-level data should only be available to public health officials for the purposes of outbreak management and contact tracing

• Screening and exclusion policies should be in place for students and employees who are symptomatic or who have had an exposure to COVID-19. These individuals should be directed to self-isolate by public health authorities
• If community transmission remains low after school returns and public health measures are lifted, the use of daily screening tools can eventually be eliminated
• The need for confirmation of screening, the location of screening (home vs. school) and the screening / exclusion criteria (i.e., number of symptoms, duration of symptoms, presence of symptomatic household members, recent exposure), should be adjusted based on the local COVID-19 risk scenario (see table below)

Continue with lab-based molecular testing for those with symptoms and high-risk exposure. Asymptomatic testing is not routinely recommended, especially in low- to moderate-risk situations. Testing in asymptomatic children and youth is only necessary if there is high-risk exposure to someone with COVID-19.

Encourage frequent and proper hand hygiene in schools. Children and youth should be taught how to clean their hands properly, and should be directed to avoid touching their face, nose, eyes, and mouth. Students and staff should perform hand hygiene when entering and before leaving school buildings. Access to hand hygiene facilities should be improved and a regular schedule for hand hygiene should be established.

COVID-19 is transmitted by aerosols and respiratory droplets. Therefore, identifying and prioritizing schools that require ventilation upgrades, as indicated by not meeting the minimum guidelines from The American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standard 62.1-2019 is recommended. School boards must invest in school heating, ventilation, and air conditioning infrastructure with regular maintenance. In addition, using outdoor learning environments and keeping classroom windows open can promote improved ventilation.

The following recommendations should be considered when developing environmental cleaning protocols for schools:

• Regular cleaning schedules should be established, with high-touch surfaces being prioritized
• Health Canada-approved disinfectants should be used
• Students and staff should be discouraged from sharing food, water bottles, and cutlery
• There is no need to quarantine paper products since the risk of transmission through surfaces is low

Using non-medical masks and medical masks have been effective in reducing COVID-19 transmission. However, there are also negative consequences of masking, including a negative impact on communication and social interactions. Therefore masking should be a temporary measure implemented only when there is moderate or high transmission of COVID-19 in the community.

Physical distancing is useful as a temporary measure but social interaction is essential for children/youth and should be encouraged when possible in accordance with public health guidelines. Physical distancing should only be considered in moderate/high-risk scenarios. Aim for a 1-metre distance only when distancing is required.

In high schools and middle schools, masking and physical distancing is preferred over cohorting in moderate and high-risk scenarios. For kindergarten and elementary school students and for children with medical complexities, cohorting is recommended (students stay with the same class indoors). However, cohort mixing can be allowed during recess.

Lack of in-person gatherings have had a substantial impact on student physical and mental health. With high vaccine rates and low community transmission, there should be a return to in-person gatherings with cancellation only in high-risk scenarios. Large-well ventilated areas should be prioritized for in-person activities. Rapid antigen testing may be considered only in high community risk scenarios, especially those with high aerosol dispersion (i.e. music practices).

In moderate and high-risk scenarios, temporary health and safety measures (i.e. symptom screening by parents, reducing children on the bus, masking) should be considered on buses. Windows should be kept open if possible.

• Schools administrators and school boards will be responsible for implementing measures set out by the Ministry of Education, Ministry of Health, and the local public health unit to prevent the spread of COVID-19 during the academic year. 
• In the event that a student or staff member contracts COVID-19, this will be communicated to families through the school board’s website. 
• School boards will be required to set up a COVID-19 advisory section on their website where this information can be found.
• The identity of a student or staff member who has tested positive for COVID-19 will remain anonymous. 
• If the local public health unit advises that the school should be closed, students, staff and parents will be informed immediately.

• Those who test positive for COVID-19 will be asked to remain in isolation for 14 days and stay home until they are cleared to return to school by a health provider or public health unit. 
• Every individual who tests positive for COVID-19 will be contacted by their public health unit for follow-up. 
• Schools should be able to provide education remotely to students who are self-isolating.

• An outbreak in a school setting is defined as two or more confirmed cases of COVID-19 within a 14-day period, where at least one case could have been contracted within the school. 
• School administrators will be responsible for reporting a probable or confirmed case of COVID-19 to the local public health unit in the area if they become aware of it.
• Schools will also monitor student absenteeism and share this information with the public health unit as requested for timely follow-up with families. 
• In case of an outbreak, the public health unit will determine which student cohort(s) should be sent home and whether a full or partial school closure is required.

• The local public health unit will declare the outbreak over when 14 days have passed since the last school-associated case and no other symptomatic individuals are waiting to be tested.
• A school outbreak does not necessarily need to be over to re-open the school (e.g. student cohorts in which there is no active transmission of the virus may be brought back to school).

• Students should be aware of how to identify COVID-19 symptoms and report to school staff if such symptoms are observed. 
• If a student or staff member becomes ill during school hours, anyone providing care to the individual should maintain physical distance, wear a protective mask and eye protection. 
• Environmental cleaning of the areas where the ill individual was present during the day will take place.
• The ill individual and their parent/guardian will be advised to seek medical attention and COVID-19 testing.
• Even if the staff or student tests negative for COVID-19, they should not return to school until at least 24 hours after their symptoms have resolved.

• School boards may consider implementing additional planning and transition time for students with special needs.
• The option of daily attendance should be offered for students with adapted timetables if remote learning is difficult based on the students’ special education needs.
• School boards may work with regulated health professionals, social service professionals and others to deliver school-based supports for students.