Planning for the 2021-2022 school year in the context of COVID-19 vaccination

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As COVID-19 continues to circulate in Canada and more people are getting vaccinated, different public health measures (PHMs) will be required based on the level of transmission and other key indicators outlined below.

This interim guidance provides schools with advice for planning and operating during the 2021-2022 school year, including how they can adjust PHMs in the context of COVID-19 vaccination in Canada. It combines the archived versions of guidance for Schools Kindergarten to Grade 12 (published in August 2020) and Post-Secondary Institutions (published in July 2020).

This guidance has been developed in alignment with the Federal/Provincial/Territorial Public Health Response Plan for Ongoing Management of COVID-19, which provides a common forward-planning approach for the on-going management of COVID-19 in Canada. It is based on the current Canadian context, emerging evidence, expert opinion, and the concepts outlined in the Individual and community-based measures to mitigate the spread of COVID-19 in Canada. Additionally, guidance on adjusting individual and community-based measures is available in the Adjusting public health measures in the context of COVID-19 vaccination. Regional and local public health authorities (PHAs) and school administrators may also refer to Readiness criteria and indicators for easing restrictive public health measures for additional information on whether and when to instate, maintain, ease or re-instate PHMs; and COVID Trends to learn more about local COVID-19 activity in a specific region.

This guidance is not prescriptive in nature; rather, it aims to provide recommendations that can support individual and community-based measures considered by Provincial/Territorial (PT) authorities going forward. It should be read alongside, and in support of relevant PT and local legislation, regulations, and policies.

Target audience

The primary audiences for the guidance include relevant government departments, administrators of schools from kindergarten to grade 12 (K-12), administrators of post-secondary institutions and regional/local PHAs in jurisdictions where these settings exist. In this document, the term school is used interchangeably to refer to both K-12 school settings and post-secondary institutions.

This guidance provides information for both private and public schools, including:

While this document provides guidance in school settings, other groups, such as those responsible for child/youth settings and programs (e.g. daycares, day programs/camps) and those responsible for community settings and programs targeting students (e.g., off-campus associations and team-based programs) may find aspects of this guidance useful for adjusting PHMs as more people in Canada become vaccinated against COVID-19. This guidance does not include advice for businesses and retail operations within post-secondary settings such as pubs/bars, restaurants and shops. For further information related to these settings, refer to relevant provincial/territorial guidance, and the risk mitigation tool for operators of community settings.

Impact of COVID-19 restrictions on students and communities

Beyond the integral role that schools play in a student’s education, they also have many important impacts on communities and the overall development of students. Children and youth in particular have experienced an unprecedented duration of school closures in many jurisdictions, which have had negative psychological, educational and/or physiological impacts on studentsFootnote 1 Footnote 2. Online education does not provide the same degree of socialization as in-person learning. Further, shutdowns of in-person learning have the potential to lead to education gaps and may have lasting impacts on child development, health and education and may amplify existing inequalities, particularly among lower income families Footnote a Footnote 1 Footnote 3 Footnote 4 Footnote 5 Footnote 6.

In particular, the mental health of some children and adolescents has been negatively impacted by school closuresFootnote 1 Footnote 7. This has also contributed to negative behavioral outcomes in children (e.g., conduct and emotional problems, etc.), as well as anxiety and depressive symptoms, increased substance use, and social isolation among adolescentsFootnote 1 Footnote 7. Given the significant impacts of K-12 school closures, regional/local PHAs are encouraged to prioritize in-person education as PHMs are adjusted, so that schools are one of the last settings to be closed and one of the first to be re-openedFootnote 2 Footnote 7. Additionally, if the local epidemiology indicates the need for additional PHMs, it may be beneficial to continue in-class learning, even if extra-curricular activities are curtailed or paused.

Applying a social determinants of health lens when planning for the 2021-2022 school year will be important as administrators consider the impact school closures and other reduced or limited services or activities have had on students and their families. For example, school closures in the 2020-2021 school year contributed to delays in childhood school-based immunization, cancellation of school meal programs and the introduction of financial strain for some families. As well, students with disabilities and from lower income families with reduced access to a home computer may have been challenged to access online education programs, and thus contributed to an educational disparity among these populations. Resources to minimize these impacts are available:

A risk-based approach to COVID-19

Transmission of SARS-CoV-2

Understanding how SARS-CoV-2, the virus that causes COVID-19, is transmitted helps to inform a risk assessment and implementation of corresponding risk mitigation measures to help reduce the spread of COVID-19. For more information, refer to PHAC’s Modes of Transmission webpage and guidance on Individual and community-based measures to mitigate the spread of COVID-19 in Canada.

For K-12 schools specifically, it is important to consider the transmission dynamics of SARS-CoV-2 in children/youth and school settings, while recognizing that those less than 12 years of age will not be eligible for COVID-19 vaccine, and that evidence may change, particularly concerning variants of concern (VOCs). While transmission of SARS-CoV-2Footnote b can occur in K-12 schoolsFootnote 8 Footnote 9 Footnote 10 Footnote 11 Footnote 12 Footnote 13 Footnote 14, there may be a lower risk of child-to-child and child-to-adult transmission in primary schools relative to secondary schools when PHMs are in place and adhered to, although evidence around this is still emerging and further research is required. However, widespread transmission in these settings has been observed when multiple mitigation measures are not present or being followedFootnote 15 Footnote 16 Footnote 17 Footnote 18. While younger children, especially those below 10 years of age, may experience less frequent and less severe symptoms from COVID-19Footnote 19 Footnote 20 Footnote 21, it remains important to minimize transmission to reduce the risk to children and those around them.

Although limited evidence exists in the context of VOCs, the majority of evidence to date indicates that adherence to multiple layers of mitigation measures can be effective in limiting the transmission of SARS-CoV-2 in child/youth settings, including K-12 schoolsFootnote 12 Footnote 22. At the time of publication, there is a lack of high quality evidence to describe the differences between VOC transmission in K-12 settings compared to the broader communityFootnote 23; evidence will continue to be monitored for the impact of VOCs on the child/youth population.

Post-secondary institutions have similarly experienced outbreaks among their student populations, in some cases leading to incidence above that of the local communityFootnote 24. There is a lack of high-quality evidence at this time regarding the combined impact of VOCs and vaccinations in this population. Additional considerations specific to this population that contribute to outbreak potential are a greater than average number of social contacts, shared accommodations, and potentially lower intention to vaccinateFootnote 24.

Transmission of SARS-CoV-2 is less likely to occur among highly vaccinated populations compared to unvaccinated populations due to the reduced rate of infections and/or reduced viral load should a person who is vaccinated contract COVID-19Footnote 25 Footnote 26 Footnote 27 Footnote 28. Therefore, it is important to maximize vaccination coverage in the school setting and in the community (among those who are eligible) before the start of the 2021-2022 school year to reduce the risk of SARS-CoV-2 transmission and/or local outbreaks once in-person learning begins.

Risk assessment and mitigation for COVID-19 in schools

The risk associated with transmission of SARS-CoV-2 in school-based settings is based on a variety of factors, such as local community and school epidemiology, characteristics of the setting (e.g., size of indoor space, areas with large gatherings), as well as the people accessing the setting, and should be assessed in advance of organizing in-person programs or operations. Vaccines lower the risk of severe outcomes even if some transmission occurs, and assessing overall risk should take this into account. When considering implementation of PHMs, it is also important to consider unintended consequences of interventions and weigh COVID-19 risks against other potential harms (e.g., mental health impacts of school closures).

PHAC’s Reducing COVID-19 risk in community settings: A tool for operators risk mitigation tool has been designed to assist operators and administrators of various community settings, including schools, to assess the risk of COVID-19 in community settings based on: local COVID-19 activity, physical characteristics of the setting, people who access the setting, and the activities and interactions that take place in the setting. The tool allows users to identify mitigation strategies to reduce the risk of COVID-19 within their specific setting.

As well, schools should work closely with their local transportation authority and regional/local PHAs in the implementation of transportation related risk mitigation measures. Regional/local PHAs will provide advice on what individual and community-based PHMs are required, based on local circumstances.

COVID-19 vaccination

As noted in the Canadian Immunization Guide, vaccines are a cornerstone of public health and their use has significantly contributed to the prevention and control of infectious diseases in Canada and internationally. Vaccinating eligible individuals (for COVID-19, along with other vaccine preventable diseases) is an important measure that will help to reduce incidence of infectious diseases in the community. COVID-19 vaccines are effective at preventing serious outcomes, such as severe illness, hospitalizations and death due to COVID-19, as well as reducing the risk of infection and transmission among those vaccinatedFootnote c. At the time of publication, COVID-19 vaccines have been authorized for use in individuals 12 years of age and older, and clinical trials are currently underway for COVID-19 vaccines in younger children. However, it is projected that vaccination coverage among the eligible Canadian population (i.e., those 12 years and older) will increase and support a gradual adjustment of PHMs in community-based settings, including schoolsFootnote 29.

Current studies provide evidence of local community outbreaks despite highly vaccinated populationsFootnote 30 Footnote 31 Footnote 32, particularly in the context of VOCs and among those who remain unvaccinated. However, the incidence of severe outcomes, such as hospitalizations and deaths, is reduced with increased levels of vaccine coverageFootnote 33. Regional/local PHAs should work with relevant school administrators to identify methods of increasing vaccine coverage in the school population and encourage all those who are eligible to be vaccinated against COVID-19. For example, schools could promote communication and outreach strategies (e.g., emails, signage at school entry points) to encourage vaccination for all those who are accessing the setting and who are eligible. Communications should be written in plain language and in alternate formats as needed to facilitate effective communication for individuals with disabilities, or those whose first languages are not English or French and, where appropriate, in partnership with trusted community-based organizations to meet the need of diverse populations.

Schools may wish to work with appropriate authorities (e.g., regional/local PHAs, immunization services, etc.) to offer on-site vaccination clinics to increase vaccination coverage (with parental consent as required) among the eligible school population. If the school or immunization services cannot support on-site vaccinations, accommodations, such as flexibility around absences, could be provided for students and staff to access off-site vaccination clinics. The school may also support immunization activities by contributing to transport of students to immunization clinics, assisting with consent forms, and promoting immunization, in collaboration with regional/local PHA.

Despite widespread vaccine roll-out, some individuals may choose not to or are unable to be vaccinated against COVID-19 for various reasons including eligibility, age, and/or contraindications. It is important to ensure that these individuals are not stigmatized for their vaccination status.

Adjusting school-based public health measures

Guidance is available on Adjusting public health measures in the context of COVID-19 vaccination and provides advice on core PHMs, such as staying at home if ill, hand hygiene and respiratory etiquette, as well as additional PHMs such as physical distancing and masking when appropriate and required. It is anticipated that there will be multiple respiratory viruses circulating in the community and in schools this fall, such as influenza and respiratory syncytial virus (RSV), and considering measures that are appropriate for all viruses will help create a sustainable approach. Therefore, consideration of core PHMs that are appropriate for a range of infectious pathogens that may circulate among students in schools will help create a sustainable approachFootnote 34.

Regional/local PHAs would benefit by having plans available for instating, maintaining, easing, or re-instating core and additional PHMs. Plans for adjusting PHMs should consider several key indicators as listed in the Adjusting public health measures in the context of COVID-19 vaccination guidance. The indicators that particularly impact the risk associated with COVID-19 in schools and communities include the evolving vaccine eligibility for those less than 12 years of age; impacts of vaccination coverage within the broader eligible community on schools; as well as the potential risks should VOCs with immune escapeFootnote d become establishedFootnote 35 Footnote 36.

Core and additional PHMs may be recommended based on the level of risk (lower risk vs. higher risk) of COVID-19 spread in the local community and school. However, the unintended consequences of PHMs should also be carefully weighed before implementing.

Regardless of vaccination status of students, it is important that schools consider measures to protect the student population and those around them from risk of severe disease or outcomes from COVID-19. In consultation with the regional/local PHA, the school should monitor the uptake of PHMs (i.e., adherence) and adjust as necessary to address challenges in implementation and changes in local community or school epidemiology.

As more people in Canada are vaccinated against COVID-19, it will be important to optimize testing, screening and surveillance activities that can manage localized outbreaks, while maintaining surge capacity in the event of increased incidence or an immune escape VOCFootnote d. Testing technologies and strategies will need to take into account the epidemiology of COVID-19 and vaccine coverage in the population.

Settings with low vaccination coverage

In settings where there is low vaccination coverage (e.g., primary schools where most of the students are under 12 years of age, or populations where large numbers of individuals choose not to receive the vaccine), the introduction and transmission of SARS-CoV-2 within the school setting and into the local community is possible. This may include transmission to individuals who are not vaccinated and those who are at an increased risk for severe disease or outcomesFootnote 32. Implementing PHMs in these settings, such as improved indoor ventilation, screening and testing strategies, mask wearing and physical distancingFootnote 18 Footnote 37, may be considered to reduce the risk of transmission of SARS-CoV-2 and/or local outbreaks. When determining whether these measures may be appropriate, it will be important to consider both COVID-19 risk and the risk of unintended consequences of the measures.

Indoor ventilation

Ventilation has an important role in reducing the risk of SARS-CoV-2 transmission, especially in indoor settingsFootnote 38 Footnote 39 Footnote 40. For schools that have heating, ventilation and air conditioning (HVAC) systems, it is recommended, if possible, that a professional be consulted to ensure that it is properly designed, maintained, and functioningFootnote 41. Other ways to help improve ventilation include holding activities outdoors, and opening exterior windows and doors when it is safe to do soFootnote 38 Footnote 42 Footnote 43. If opening a window is not possible while the room is occupied, schools may consider opening windows between occupancies/classesFootnote 44, or moving activities to a better ventilated space (e.g., outdoors, a larger space, a room with mechanical ventilation from an HVAC system), when possible.

In the absence of appropriate natural or mechanical ventilation, schools may consider using portable high efficiency particulate air (HEPA) air filters, while ensuring that expert advice is provided on the appropriate device required for the size of the room, occupancy levels and the type of activities that will take placeFootnote 45 Footnote 46 Footnote 47. However, portable HEPA air filters should not be used as a replacement for proper indoor ventilation; rather, they should only be used during periods of inadequate ventilation measuresFootnote 45 Footnote 46 Footnote 47.

For additional information on how indoor ventilation can reduce COVID-19 spread, see PHAC’s COVID-19 Guidance on Indoor Ventilation During the Pandemic.

Screening and testing

As advised by PTs and regional/local PHAs, schools may consider implementing symptom screening programs for students, faculty, and staff, especially in populations with low vaccination coverage, such as elementary and/or middle schools where a large proportion of students are not vaccinated (i.e., children less than 12 years of age). Passive and active symptom and exposure risk screening for COVID-19 can contribute to reducing the risk of SARS-CoV-2 transmission in schools (i.e., community-based settings) by helping to identify individuals who may have symptoms of COVID-19 so they do not enter the premises or can be separated from others if already on the premises.

Testing strategies, as practiced by other jurisdictions and countriesFootnote 48 Footnote 49 Footnote 50 Footnote 51 Footnote 52, may be considered to assist in rapidly identifying and containing the spread of COVID-19 in school settings, particularly during a local community or school COVID-19 outbreak. The school should follow regional/local PHA advice regarding appropriate testing modalities and strategies, recognizing that PCR tests, rapid tests and self-tests may all have a role in the recommended testing strategies. Testing and screening will continue to be important in the ongoing management of COVID-19.

Canada’s Expert Panel on Testing and Screening recognizes that 30% to 50% of children with SARS-CoV-2 infection are asymptomatic. The panel encourages screening test strategies where community prevalence suggests it would be beneficial, including through the use of rapid tests to screen for COVID-19 cases as a complement to lab-based PCR testing. Furthermore, self-tests may become available in the near future that offer students, staff and parents the opportunity to conduct testing at home to help identify SARS-CoV-2 infection.

Schools should have communication strategies in place targeting students and staff, as well as parents and guardians to ensure that individuals do not enter the school setting if they are experiencing symptoms compatible with COVID-19 (as defined by the PT), have tested positive for COVID-19, or are otherwise instructed by the regional/local PHA that they must quarantine or isolate. It is also important to consider that other respiratory illnesses (e.g., influenza, RSV) may circulate during the fall and winter. Schools should be aware that there may be mildly symptomatic individuals who test negative for COVID-19, but may still have another respiratory illness or condition.

For additional information, guidance is available on priority strategies to optimize testing and screening for primary and secondary schools, which provides evidence-informed advice on existing approaches to testing and symptom screening measures to support in-person learning, with recommendations focused primarily on communities with high or increasing community transmission of SARS-CoV-2.

Mask wearing

In some circumstances, regional/local PHAs may recommend, or schools may choose to implement, mask wearing as an additional measure in schools when the local community or school are at higher risk for COVID-19 spreadFootnote 53.

A well-constructed, well-fitting and properly worn mask has been shown to protect the wearer and those around themFootnote 53 Footnote 54 Footnote 55 Footnote 56 Footnote 57 Footnote 58 Footnote 59. Mask wearing may also be encouraged when physical distancing is not possible (i.e., indoor public places, crowded outdoor settings, during activities with close contact with others)Footnote 60 Footnote 61 Footnote 62. It is important to recognize that some people may choose to wear a mask based on a personal risk-assessment (e.g., those who are at a higher risk of severe disease or outcomes)Footnote 63 Footnote 64. It is also important that these individuals are not stigmatized for their choice. Further, school administrators will need to accommodate the needs of students with disabilities and ensure that they have access to the same public health information and, to the extent possible, appropriate mitigation measures (e.g., assistance with mask wearing).

Compared to the potential negative consequences associated with school closures and online learning noted above, mask wearing can prevent SARS-CoV-2 transmission among unvaccinated childrenFootnote 55 Footnote 65 Footnote 66 and may also help reduce transmission of other respiratory conditions within school settings (e.g., influenza, RSV)Footnote 67 Footnote 68 Footnote 69. Existing studies show that mask use among children does not significantly impair their physiological health (i.e., respiratory function); however, consistent adult supervision on the correct and safe wearing of masks is strongly encouraged to prevent respiratory impairmentsFootnote 70 Footnote 71. There is no strong evidence suggesting negative consequences of mask wearing in childrenFootnote 70 Footnote 72 Footnote 73 Footnote 74.

Physical distancing and cohorting

In some circumstances, regional/local PHAs may recommend, or schools may choose to implement, physical distancingFootnote e as an additional measure when the local community or school are at higher risk for COVID-19 spread. Although physical distancing can reduce the risk of SARS-CoV-2 transmissionFootnote 75 Footnote 76 Footnote 77, it can be challenging to implement in school settings where space may be limited and personal interactions are required during the learning processes.

Schools may choose to cohort students, implement distancing between the cohorts, and/or stagger cohort activities if/when a local circumstance warrants physical distancing recommendations, or when advised by the regional/local PHA.

This is why it is important, when directed by the regional/local PHA based on local COVID-19 epidemiology and other indicators, to take a “layered approach” and adhere to other PHMs, such as indoor ventilation, screening and testing measures, and mask wearing to minimize the risk of spreading COVID-19. When regional/local PHAs are determining whether to recommend physical distancing measures, it will be important to consider both the risk of COVID-19 and the unintended consequences of the measures.

Reporting and outbreak management

It is important for administrators of K-12 institutions to understand the usual absenteeism patterns of their school, as well as the symptoms associated with COVID-19 and other respiratory illnesses that may circulate during the fall and winter, recognizing that it may be challenging to distinguish between COVID-19 and other respiratory illness symptoms. Schools should have plans in place for early recognition of individuals potentially infected with COVID-19 and prevention of ongoing COVID-19 spread, in addition to established processes for symptom/case reporting, information sharing and supporting the regional/local PHA in their case management and contact tracing efforts as required. It is recommended that notification to the regional/local PHA occurs in the event of an outbreak; during unusual situations, such as when absenteeism of students, staff or volunteers is greater than expected; or when severe illness is observed. For additional information, PHAC’s outbreak investigation guidance for K-12 school settings is available.

Post-secondary institutions are unlikely to monitor class attendance or to track absenteeism due to the nature of the format of education delivery, variable attendance policies and the composition of the student population (i.e., young adults and mature students). In the event that case and contact management will be required, jurisdictions may wish to consider digital programs (e.g., web-based apps, QR codes) to assist in these public health efforts. As required, students on-campus and in post-secondary housing should be made aware of how to seek testing (e.g., in the event of a local school/community outbreak). Standard protocols for notification/reporting infections, contact tracing and isolation (as appropriate) should be in place.

School administrators should develop plans, in consultation with their regional/local PHA, to help guide their actions in the event of a COVID-19 outbreak in their school. Plans should consider specific policies regarding case and contact management, environmental cleaning and disinfecting protocols, and temporary alternative education-delivery models. Regional/local PHAs will advise on testing and separation and/or exclusion of students, staff and volunteers, as required.

Communication plans should maintain privacy when providing information to students, parents/families/guardians, the school staff/volunteers, and local communities. The roles and responsibilities of the school, regional/local PHA, and other stakeholders in the event of an outbreak should be identified in advance of a return to school.

Additional considerations

Communication strategies

Communication activities for K-12 and post-secondary students, staff and parents/guardians (e.g., reminders, stories, videos) that are age appropriate, inclusive, actionable and accessible are important to continue. Clearly communicate what people can do to keep themselves and those around them safer, and the rationale for recommendations. These approaches can help foster a sense of competence and efficacy, which can facilitate adherence to recommended PHMsFootnote 78. This transparency can help to promote adherence because individuals can understand the rationale behind the decisions and the effectiveness of the measures required, and can prepare for these changesFootnote 79 Footnote 80 Footnote 81. It will also be important to clearly communicate that it is acceptable for PHMs to still be maintained by individuals as more people in Canada become vaccinated against COVID-19; this can help to avoid stigmatization towards students who choose to adopt certain practices (e.g., mask wearing, physical distancing, screening programs), and support public health efforts in limiting the transmission of COVID-19 and other respiratory illnesses. One strategy could be supporting and encouraging people to act in ways that help or benefit other people, and to do their part to help keep each other safe. When people feel like they are a part of a group or community response (e.g., their school community), they may be more likely to follow PHMs; this is particularly true if they see other people following PHMsFootnote 82.

It will be important for K-12 schools to keep parents/guardians informed of the school expectations (e.g., keeping ill students at home, notification of absences), as well as what the school is doing to prevent SARS-CoV-2 transmission and promote health protective behaviors. Schools should also encourage parents to follow regional/local PHA advice on getting vaccinated against COVID-19 if eligible, and what to do at home to prevent the spread of respiratory infections, including COVID-19. Communication should include references to the regional/local PHA, use plain language, provide strategies for equitable access to supports, and be as accommodating as possible for families with disabilities or those whose first languages are not English or French.

In consultations with the regional/local PHA, the school should communicate policies to staff and ensure that they stay home if they are ill, have tested positive for or are showing symptoms of COVID-19 and develop flexible policies that allow staff to take time off without negative consequences, while ensuring that these individuals are not stigmatized and their privacy is respected.

It is important that the regional/local PHA, school administrators, students, staff, and parents/guardians are engaged and involved in the planning process in the event of a local outbreak (e.g., via parent-teacher association meetings, social media, surveys).

Social gatherings, events and activities

Based on advice from the regional/local PHA when the local community or school are at lower risk of COVID-19 spread, students are likely to increasingly engage in social activities, both on- and off- the school property or campus. Administrators and regional/local PHAs should provide information to students to ensure that they are aware of regional/local PHA’s recommendations, school policies and operational guidance on gatherings.

When the local community or school are at higher risk for COVID-19 spread, it may be beneficial to remind students of risk-reduction measures appropriate for in-person gatherings. This may include advice for individuals who are vaccinated (i.e., depending on vaccine effectiveness, particularly against VOCs), as well as individuals who are partially vaccinated or unvaccinated and attend gatherings. In addition, it may be useful to provide suggestions of alternatives that are lower risk of COVID-19 spread (e.g., virtual events, smaller gatherings, outdoor activities, wearing masks during events) that still allow them to feel connected with their peers. Younger people tend to adhere to PHMs when they perceive that they, or people whom they care about, could be at risk for contracting COVID-19Footnote 83.

However, despite recommendations from the regional/local PHA, it is important to acknowledge that if older children and post-secondary students do choose to gather in-person during periods of higher risk of COVID-19 spread, substance use (e.g., drugs and/or alcohol), among other factors, may impair their assessment of risk and reduce adherence to PHMsFootnote 84 Footnote 85 Footnote 86. Strategies for the safe consumption of substances should be promoted by school administrators and local PHAs for overall student well-being, and may also improve adherence to the recommended PHMs when private social gatherings do take place.

For additional information about individual-level risk assessments, refer to the My COVID-19 Visit Risk Calculator, a web-based tool for assessing the individual-level risk of becoming infected with COVID-19 when visiting or gathering with others.

Travel and international students

Special consideration should be given to school attendance by individuals coming from outside the community, such as interprovincial and international students. It is recommended that protocols be in place to support individuals travelling back to Canada and to prevent potential discrimination based on their race or country of origin.

Local, provincial/territorial and/or national requirements for domestic and international travelers may necessitate a period of quarantine prior to integration into school activity. All travelers entering Canada must meet any applicable testing and quarantine requirements enforceable through an emergency order under the Quarantine Act.

As travel-related quarantine measures continue to evolve, regional/local PHAs and the resources below should be consulted to determine current restrictions that may impact people at or planning to attend the school settings.

Further information for students and administrators can be found at Immigration, Refugee and Citizenship Canada:

Organized activities in the school setting

Physical education and recreation activities

Physical activity plays a meaningful role in many school settings as it provides a sense of community, facilitates individuals' physical and mental health and promotes social connectednessFootnote 87 Footnote 88.

It may be prudent to consider the risks associated with SARS-CoV-2 transmission during sports and recreation due to the production of infectious respiratory droplets and aerosols from heavy breathing or shouting (e.g., during recess or physical education, particularly indoors), especially during periods of increasing transmission or community outbreaks.

Extracurricular activities, such as varsity and intermural sports, can also pose a greater risk for SARS-CoV-2 transmissionFootnote 89 Footnote 90, especially those that are high-contact or team sports. When the local community or school are at higher risk for COVID-19 spread, schools may opt to choose activities where physical distancing can be maintained or when they can take place outdoors. High-contact or team sports can be considered when the local community or school are at lower risk of COVID-19 spread.

Music, band, singing and choir

Playing wind or brass instruments may increase the risk of SARS-CoV-2 transmission, due to the production of infectious droplets and aerosols or by playing an instrument recently used by a person who has COVID-19Footnote 24 Footnote 91. Although definitive evidence of increased SARS-CoV-2 transmission related to these activities is lacking, additional precautions should be takenFootnote 92. The evidence is evolving and will continue to be monitored and updated, as more is known.

Singing in indoor settings contributes to the transmission of SARS-CoV-2 when one of the participants has COVID-19Footnote 91 Footnote 92 Footnote 93. Risk is considered even greater when singing takes place in a closed space, with poor ventilation, or a crowded space.

As advised by regional/local PHAs and according to local risk for COVID-19, schools may consider specific mitigation measures, such asFootnote 94:

For additional information on cleaning and disinfecting in school settings (i.e., public spaces), refer to PHAC’s guidance on COVID19: cleaning and disinfecting.

Boarding schools and post-secondary housing

Boarding schools and post-secondary housing have unique considerations as congregate living settings where the risk of acquiring and/or transmitting SARS-CoV-2 may be elevatedFootnote 95. School administrators should develop plans in consultation with the regional/local PHA for opening boarding schools or post-secondary housing based on a school risk assessment. For additional information on risk mitigation strategies in congregate living settings, see Appendix C of the Individual and community-based measures to mitigate the spread of COVID-19 in Canada.

Administrators of boarding schools and post-secondary housing should consider strategies to encourage COVID-19 vaccination uptake among students; they may also consider implementing policies to monitor vaccine uptake among students living in residences.

As advised by the regional/local PHA, and when the local community or school are at higher risk for SARS-CoV-2 transmission and/or there is low vaccine coverage, administrators of boarding schools and post-secondary housing may choose to implement testing strategies at the beginning of the school year and consider frequent testing during COVID-19 outbreaks to assist in rapidly identifying and containing the spread of COVID-19. Testing sites in these settings may be helpful for student accessibility.

Administrators should also consider the possibility that restrictions to travel may be imposed during the academic term, preventing some students from leaving or returning to their boarding schools or post-secondary housing. It would be important for administrators to inform the student population if any restrictions are in place for those who travel domestically or internationally for pleasure, work, or family-related matters. In situations where students cannot return home and must remain in their school residence, they may need various supports (including mental health) and services during periods when the school traditionally closes or operates at reduced levels (e.g., winter break).

Regional/local PHAs and school administrators may refer to the following resources:

Managing COVID-19 illness in boarding schools and post-secondary housing

Due to the nature of congregate living settings, schools should ensure that effective plans and protocols are in place to manage illness in boarding schools and post-secondary housing. Schools should develop plans for managing individuals who become symptomatic or have had an exposure to COVID-19 while in the setting. This may include quarantine or isolation measures; how to report illness or exposure and seek emergency medical care if needed; and implementing more frequent environmental cleaning and disinfecting measures in areas accessed by an individual who is ill.

When the local community or school are at higher risk of COVID-19 spread or there is an outbreak in the boarding school or post-secondary housing, it will be essential that the institution work closely with the regional/local PHA and support their efforts to prevent transmission. School administrators may consider the following factors in their safety planning:

In the event that administrators may need to address COVID-19 illness or outbreaks on campus, they may find it beneficial to have established policies and procedures in place. In developing policies and procedures for such circumstances, the following can be considered:

For regional/local PHAs, see Public health management of cases and contacts associated with COVID-19 guidance for additional information.

Considerations for employees

Specific advice for school employees is out-of-scope for this guidance. However, the following resources may be considered in addition to relevant guidance and requirements from the regional/local PHA and jurisdictional health and safety regulator:

It will be important for school administrators to consult with their health and safety committee or representative to assess the risks of COVID-19 for their specific workplace and implement appropriate hazard controls based on their community needs, relevant PT and regional/local PHA advice, and local epidemiology. Some general considerations with respect to employees may include:

Considerations for remote, isolated and Indigenous communities

It is important to respect and support Indigenous self-determination, as well as respectfully recognize the disproportionate burden of communicable diseases on some Indigenous communities, and the legacy of past pandemics. Local surveillance programs (where relevant), community health centers, and the local PHA will be important partners in determining community risk in the school.

The overall health and well-being of people living in remote and isolated communities in Canada are disproportionately impacted by a wide range of social, environmental and economic determinants. Among those living in remote and isolated communities, important determinants include inadequate housing, poor water quality or access, food insecurity, pre-existing health conditions, and lower education and incomeFootnote 96. These factors, in addition to limited access to health care, are important to consider when adjusting PHMs. For example, practicing proper hand hygiene may be challenging in settings that are lacking access to running or clean water.

When safe to do so, schools should consider improving indoor ventilation by opening windows and doors and ensure mechanical ventilation systems are operating properly. Avoiding closed spaces or crowded places, or adequately separating a sick individual from others may be difficult in settings with overcrowding or housing shortages. In these situations, schools may consider encouraging access to on-the-land activities as a physical distancing measure. If physical distancing is not possible, schools may take a conservative approach to mask wearing (e.g., the use of medical masks in overcrowded homes).

Where schools rely on staff travelling from outside communities, they should consult with their regional/local PHA and Indigenous community leadership for support in conducting a risk assessment and identifying potential mitigation measures specific to their situation (e.g., COVID-19 vaccination, mandatory quarantine, self-monitoring for symptoms, screening and testing). Considerations for resuming in-school classes may include the availability of staff and contingency plans for staff shortages (e.g., due to illness or post travel quarantine). Schools that are outside of, but in close proximity to Indigenous communities and have a high number of students from nearby Indigenous communities should engage Indigenous leadership in the development of their in-person learning plans.

When possible, efforts to prevent SARS-CoV-2 transmission should not infringe on important cultural activities, on-the land activities, and/or traditional ceremonies (e.g., reading, circle time or story telling in a group; sharing of food/drink). Administrators should ensure that these activities can take place as safely as possible.

Many schools in remote, isolated, and Indigenous communities are in need of additions, renovations, and maintenance projects and may not easily allow optimal ventilation in buildings within these settings, or the implementation of other risk mitigation measures such as consistent physical distancing between students, staff, and volunteers. As in other contexts, a layered approach to risk mitigation including both individual and community-based PHMs (e.g., screening and testing strategies, improved ventilation, mask wearing, and physical distancing), will be particularly important when there is a higher risk for COVID-19 spread in the local community or school.

Additionally, there are a variety of barriers that must be considered when increasing vaccination coverage for Indigenous peoples and those living in remote and isolated communities. These barriers must be addressed appropriately, as these efforts will be important aspects of minimizing incidence of cases, hospitalizations and deaths due to COVID-19. More information is available at Indigenous Services Canada.

For additional information, guidance for Remote and isolated and First nations, Inuit and Metis communities.

Additional resources


This technical guidance was developed in consultation with the Canadian Pandemic Influenza Preparedness (CPIP) Task Group and with federal, provincial and territorial partners, via the Technical Advisory Committee (TAC) and/or the Special Advisory Committee (SAC). This guidance was also developed in consultation with other government departments, various multilateral partners, Indigenous stakeholders, and other external stakeholders with an interest in this subject matter.


Footnote a

Particular groups may be disproportionately affected by school closuresFootnote 97, such as those who:

  • experience poverty or financial strain;
  • receive school-based meals;
  • rely on school-based services such as counselling;
  • experience family and gender-based violence;
  • have home-living conditions that are not supportive of online/remote learning (e.g., issues accessing technology, overcrowding, noise levels);
  • live with disabilities; and
  • rely on the certainty of education and social supports to maintain health and community inclusion.

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Footnote b

School administrators should consult regional/local PHAs for information on the rates of SARS-CoV-2 transmission in the local community. For more details, regional/local PHAs can refer to the Federal/Provincial/Territorial public health response plan for ongoing management of COVID-19, the Readiness criteria and indicators for easing restrictive public health measures and COVIDTrends.

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Footnote c

For more information, refer to Health Canada and the National Advisory Committee on Immunization.

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Footnote d

An immune escape VOC may be resistant to available vaccines or natural immunity from prior infection.

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Footnote e

For operational purposes, an appropriate physical distance is at least 2 metres. In general, if in-person interactions must take place, individuals should be encouraged to interact with those outside of their immediate household from the greatest distance possible, and with other personal preventive practices in place for a layered approach. In school settings, physical distancing may be achieved by limiting class size and preventing crowded spaces.

Return to footnote e referrer


Footnote 1

Public Health Ontario, "Negative Impacts of Community-based Public Health Measures on Children, Adolescents and Families During the COVID-19 Pandemic: Update," 2021.

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Footnote 2

World Health Organization, "Considerations for school-related public health measures in the context of COVID-19," 14 September 2020. [Online]. Available: [Accessed 5 May 2021].

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Footnote 3

Public Health Ontario, "Rapid Review: Negative Impacts of Community-Based Public Health Measures During a Pandemic (e.g., COVID-19) on Children and Families," 8 June 2020. [Online]. Available: [Accessed 8 July 2021].

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Footnote 4

United Nations Educational, Scientific and Cultural Organization, "Adverse Consequences of School Closures," [Online]. Available: . [Accessed 28 May 2021].

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Footnote 5

P. Engzell, A. Frey and M. Verhagen, "Learning loss due to school closures during the COVID-19 pandemic," Proceedings of the National Academy of Sciences of the United States of America, vol. 118, no. 17, 2021.

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Footnote 6

K. Gallagher-Mackay, P. Srivastava, K. Underwood, E. Dhuey, L. McCready and et. al, "Ontario COVID-19 Science Advisory Table (June 7 2021) COVID-19 and Education Disruption in Ontario".

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Footnote 7

European Centre for Disease Prevention and Control, "COVID-19 in children and the role of school settings in transmission - second update," 8 July 2021. [Online]. Available: [Accessed 23 July 2021].

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Footnote 8

Centres for Disease Control and Prevention, "Science Brief: Transmission of SARS-CoV-2 in K-12 Schools and Early Care and Education Programs – Updated," 9 July 2021. [Online]. Available: [Accessed 23 July 2021].

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Footnote 9

Children's Task and Finish Group, "Update to 4th Nov 2020 paper on children, schools and transmission," 2020.

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Footnote 10

I. Jordan, M. de Sevilla, V. Fumado, Q. Bassat, E. Bonet-Carne, C. Fortuny and et. al, "Transmission of SARS-CoV-2 infection among children in summer schools applying stringent control measures in Barcelona, Spain," Clinical Infectious Diseases, 2021.

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Footnote 11

C. Courtemanche, A. Le, A. Yelowitz and R. Zimmer, "School Reopenings, Mobility, and COVID-19 Spread: Evidence from Texas," National Bureau of Economic Research, 2021.

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Footnote 12

S. Ismail, V. Saliba, J. Bernal, M. Ramsay and S. Ladhani, "SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England. 2021 Mar 1;21(3):," The Lancet Infectious Diseases, vol. 21, no. 3, pp. 344-353, 2021.

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Footnote 13

M. Keeling, M. Tildesley, B. Atkins, B. Penman, E. Southall, G. Guyver-Fletcher and et. al, "The impact of school reopening on the spread of COVID-19 in England," Philosophical Transactions of the Royal Society, vol. 376, no. 1829, 2021.

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Footnote 14

A. Falk, A. Benda, P. Falk, S. Steffen, Z. Wallace and T. Høeg, "COVID-19 Cases and Transmission in 17 K–12 Schools — Wood County, Wisconsin, August 31–November 29, 2020. MMWR Morb Mortal Wkly Rep 2021;70:136–140.," Morbidity and Mortality Weekly Report (MMWR), vol. 70, no. 4, pp. 136-140, 2020.

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Footnote 15

National Collaborating Centre for Methods and Tools, "Living Rapid Review Update 11: What is the specific role of daycares and schools in COVID-19 transmission?," 18 December 2020. [Online]. Available: [Accessed 14 June 2021].

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Footnote 16

European Centre for Disease Prevention and Control, "COVID-19 in children and the role of school settings in transmission- first update," 23 December 2020. [Online]. Available: [Accessed 14 June 2021].

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Footnote 17

C. Szablewski, K. Chang, M. Brown, V. Chu, A. Yousef and et. al, "SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020," Morbidity and Mortality Weekly Report (MMWR), vol. 69, no. 31, p. 1023–1025, 2020.

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Footnote 18

National Collaborating Centre for Methods and Tools, "Living Rapid Review Update 13: What is the specific role of daycares and schools in COVID-19 transmission?," 19 March 2021. [Online]. Available: [Accessed 14 June 2021].

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Footnote 19

R. Laws, R. Chancey, E. Rabdd, V. Chu, N. Lewis and et. al., "Symptoms and Transmission of SARS-CoV-2 Among Children — Utah and Wisconsin, March–May 2020 Pediatrics December 2020," Pediatrics, vol. e2020027268, January 2021.

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Footnote 20

Y. Dong, X. Mo, Y. Hu, X. Qi, F. Jiang and et. al, "Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China," Pediatrics, 2020.

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Footnote 21

J. Ludvigsson, "Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults," Acta Paediatr, vol. 109, no. 6, pp. 1088-1095, June 2020.

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Footnote 22

National Collaborating Centre for Methods and Tools, "Living Rapid Review Update 14: What is the specific role of daycares and schools in COVID-19 transmission?," 1 April 2021. [Online]. Available: [Accessed 12 April 2021].

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Footnote 23

K. Pussegoda and L. Waddell, "COVID-19 VOC transmission in children," Emerging Sciences Group - Public Health Agency of Canada., 2021. [Online]. Available: [Accessed May 2021].

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Footnote 24

National Collaborating Centre for Methods and Tools, "What is known about the risk of transmission of COVID-19 within post-secondary institutions and the strategies to mitigate on-campus outbreaks," 16 April 2021. [Online]. Available:

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Footnote 25

O. Egunsola, L. Mastikhina, L. Dowsett, B. Farkas, M. Hofmeister, L. Saxinger and F. Clement, "Transmissibility of COVID-19 among Vaccinated Individuals: A Rapid Literature Review," 2021.

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Footnote 26

R. Harris, J. Hall, A. Zaidi, N. Andrews, J. Dunbar and G. Dabrera, "Impact of vaccination on household transmission of SARS-COV-2 in England," medRxiv, 2021.

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Footnote 27

A. Shah, C. Gribben, J. Bishop, P. Hanlon, D. Caldwell, R. Wood, M. Reid, J. McMenamin, D. Goldberg, D. Stockton and S. Hutchinson, "Effect of vaccination on transmission of COVID-19: an obervational study in healthcare workers and their households," MedRixv, 2021.

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Footnote 28

"VESPa Summary Report. June 7, 2021".

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Footnote 29

National Collaborating Centre of Infectious Diseases, "The COVID-19 Public Health Agency of Canada (PHAC) Modelling Group," 5 May 2021. [Online]. Available: [Accessed 20 May 2021].

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Footnote 30

Public Health England, "SARS-CoV-2 variants of concern and variants under investigation in England. Technical briefing 15," 2021.

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Footnote 31

D. Hodgson, S. Flasche, M. Jit, A. Kucharski and C. C.-1. W. G. Group, "The potential for vaccination-induced herd immunity against the SARS-CoV-2 B.1.1.7 variant," 2021.

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Footnote 32

Public Health England, "SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing 17," June 2021. [Online]. Available: [Accessed 8 July 2021].

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Footnote 33

E. Vaileiou and et. al., "Effectiveness of First Dose of COVID-19 Vaccines Against Hospital Admissions in Scotland: National Prospective Cohort Study of 5.4 Million People," 19 February 2021. [Online]. Available: [Accessed 26 July 2021].

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Footnote 34

D. Foley and et. al., "The Interseasonal Resurgence of Respiratory Syncytial Virus in Australian ChildrenFollowing the Reduction of Coronavirus Disease 2019–Related Public Health Measures," Clinical Infectious Diseases, 2021.

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Footnote 35

C. Saad-Roy, S. Morris, J. Metcalf, M. Mina and R. Baker, "Epidemiological and evolutionary considerations of SARS-CoV-2 vaccine dosing regimes," American Association of the Advancement of Science, vol. 372, no. 6540, pp. 363-370, 2021.

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Footnote 36

W. Harvey and et. al., "SARS-CoV-2 variants, spike mutations and immune escape," Nature Reviews Microbiology, vol. 19, pp. 409-424, 2021.

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Footnote 37

S. Assache, Y. Boujija, D. Fisman and J. Sandberg, "In-person schooling and COVID-19 transmission in Canada’s three largest cities," British Medical Journal, no. doi: , 2021.

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Footnote 38

The Heating, Refrigeration, and Air Conditioning Institute of Canada, "Reducing the Risk of Virus Transmission via HVAC Systems in Schools," 2021.

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Footnote 39

Scientific Advisory Group for Emergences, Environmental, and Modelling Group, "Role of ventilation in controlling SARS-CoV-2 transmission," [Online]. Available: [Accessed 5 July 2021].

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Footnote 40

L. Morawska, J. Tang, W. Bahnfleth, P. Bluyssen and A. Boerstra, "How can airborne transmission of COVID-19 indoors be minimised?," Environmental International, vol. 142, no. 105832, 2020.

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Footnote 41

Federation of European Heating Ventilation and Air Conditioning Associations (REHVA), "COVID-19 Guidance Document," 3 August 2020. [Online]. Available: [Accessed 5 July 2021].

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Footnote 42

Government of Canada, "The Role of Bioaerosols and Indoor Ventilation in COVID-19 Transmission," 28 September 2020. [Online]. Available: [Accessed 5 July 2021].

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Footnote 43

T. Bulfone, M. Malekinejad, G. Rutherford, and N. Razani, "Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses: A Systematic Review," The Journal of Infectious Diseases, vol. jia742, 2020.

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Footnote 44

Z. Lau, K. Kaouri and I. Griffiths, "Modelling airborne transmission of COVID-19 in indoor spaces using advection-diffusion-reaction equation," arXiv, December 2020.

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Footnote 45

The Heating, Refrigeration and Air Conditioning Institute of Canada, "Reducing the risk of virus transmission in schools: Guidelines for decision-makers," January 2021. [Online]. Available: [Accessed 23 July 2021].

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Footnote 46

Canadian Agency for Drugs and Technology (CADTH),, " CADTH Technology Review: Heating, ventilation and air conditioning systems in public spaces," 22 September 2020. [Online]. Available: [Accessed 23 July 2021].

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Footnote 47

Scientific Advisory Group for Emergencies, Environmental and Modelling Group, "Potential application of air cleaning devices and personal decontamination to manage transmission of COVID-19," 4 November 2020. [Online]. Available: [Accessed 23 July 2021].

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Footnote 48

Centers for Disease Control and Prevention, "Operational Strategy for K-12 Schools through Phased Prevention," 15 May 2021. [Online]. Available: [Accessed 5 July 2021].

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Footnote 49

Public Health England, "Public Health England. COVID-19: paediatric surveillance," 2021. [Online]. Available: [Accessed 5 July 2021].

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Footnote 50

S. Ladhani, "Prospective active national surveillance of preschools and primary schools for SARS-CoV-2 infection and transmission in England," 2020.

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Footnote 51

A. Ulyte, T. Radtke, I. Abela, S. Haile, J. Braun, R. Jung, C. Berger, A. Trkola, J. Fehr, M. Puhan and S. Kriemler, "Seroprevalence and immunity of SARS-CoV-2 infection in children and adolescents in schools in Switzerland: design for a longitudinal, school-based prospective cohort study," International journal of public health, vol. 65, no. 9, pp. 1549-58, 2020.

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Footnote 52

G. Lo Moro, T. Sinigaglia, F. Bert, A. Savatteri, Gualano, MR and R. Siliquini, "Reopening Schools during the COVID-19 Pandemic: Overview and Rapid Systematic Review of Guidelines and Recommendations on Preventive Measures and the Management of Cases," International Journal of Environment , vol. 17, no. 23, p. 8839, 2020.

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Footnote 53

S. Esposito and N. Principi, "To mask or not to mask children to overcome COVID-19," European journal of pediatrics, vol. 179, no. 8, pp. 1267-70, 2020.

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Footnote 54

M. Wilson, F. Gauvin, K. Waddel, K. Moat and J. Lavis, "COVID-19 Rapid Evidence Profile #1: What is known about approaches to and safety of conserving, reusing, and repurposing different kinds of masks?," McMaster Health Forum, 14 April 2020. [Online]. Available: [Accessed 24 June 2021].

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Footnote 55

National Collaborating Centre for Environmental Health, "Masking during the COVID-19 pandemic- An update of the evidence," 20 May 2021. [Online]. Available: [Accessed 13 July 2021].

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Footnote 56

L. Asadi and et. al., "COVID-19 Scientific Advisory Group Rapid Evidence Report - Double Masking and Improved Mask Fit," Alberta Health Services, 19 March 2021. [Online]. Available: [Accessed 24 June 2021].

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Footnote 57

K. Shakya, A. Noyes, R. Kallin and R. Peltier, "Evaluating the efficacy of cloth facemasks in reducing particulate matter exposure," Exposure Science & Environmental epidemiology, vol. 27, pp. 352-357, August 2016.

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Footnote 58

A. Mueller, M. Eden, J. Oakes, C. Bellini and L. Fernandez, "Quantitative method for comparative assessment of particle removal efficiency of fabric masks as alternatives to standard surgical masks for PPE," Matter, vol. 3, no. 3, pp. 950-962, September 2020.

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Footnote 59

Public Health Agency of Canada Emerging Sciences Group, "Rapid Review on the Characteristics of Effective Non-Medical Masks in reducing the Risk of SARS-CoV-2," January 2021. [Online]. Available: [Accessed 24 June 2021].

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Footnote 60

Y. Yoon, K. Kim, H. Park, S. Kim and Y. Kim, "Stepwise school opening and an impact on the epidemiology of COVID-19 in the children," Journal of Korean medical science, vol. 35, no. 46, 2020.

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Footnote 61

The ABC Science Collaborative, "“The Reopen Our Schools Act of 2021” (S.L. 2021-4)," 2021.

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Footnote 62

H. Huppertz, R. Berner, R. Schepker, M. Kopp, A. Oberle, T. Fischbach, B. Rodeck, M. Knuf, M. Keller, A. Simon and J. Hübner, "Use of masks in children to prevent infection with SARS-CoV-2," 2020.

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Footnote 63

S. Feng, C. Shen, N. Xia, W. Song, M. Fan and B. Cowling, "Rational use of face masks in the COVID-19 pandemic," The Lancet: Respiratory medicine, vol. 8, no. 5, pp. 434-436, 2020.

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Footnote 64

Centers for Disease Control and Prevention, "Your Guide to Masks," 29 June 2021. [Online]. Available: [Accessed 8 July 2021].

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Footnote 65

J. Howard, A. Huang, Z. Li, Z. Tufekci, V. Zdimal, H. van der Westhuizen, A. von Delft, A. Price, L. Fridman, L. Tang and V. Tang, "An evidence review of face masks against COVID-19," Proceedings of the National Academy of Sciences, vol. 118, no. 4, 2021.

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Footnote 66

D. Coclite, A. Napoletano, S. Gianola, A. Del Monaco, D. D'Angelo, A. Fauci, L. Lacorossi, R. Latina, G. La Torre, C. Mastroianni, C. Renzi, G. Castellini and P. Iannone, "Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review," National Library of Medicine, vol. 7, no. 594269, 2021.

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Footnote 67

World Health Organization, "Advice on the use of masks in the context of COVID-19: interim guidance," 2020.

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Footnote 68

World Health Organization, United Nations Children’s Fund (UNICEF) , "Advice on the use of masks for children in the community in the context of COVID-19: annex to the advice on the use of masks in the context of COVID-19," 2020.

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Footnote 69

S. Del Valle, R. Tellier, G. Settles and J. Tang, "Can we reduce the spread of influenza in schools with face masks?," American journal of infection control, vol. 38, no. 9, pp. 676-7, 2010.

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Footnote 70

M. Eberhart, S. Orthaber and R. Kerbl, "The impact of face masks on children—A mini review," Acta Paediatrica, vol. 110, no. 6, pp. 1778-83, 2021.

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Footnote 71

R. Lubrano, S. Bloise, A. Testa, A. Marcellino, A. Dilillo, S. Mallardo, S. Isoldi, V. Martucci, M. Sanseviero, E. Del Giudice and C. Malvaso, "Assessment of respiratory function in infants and young children wearing face masks during the COVID-19 pandemic.," JAMA Network Open, vol. 4, no. 3, p. e210414, 2021.

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Footnote 72

Z. Qin, L. Shi, Y. Xue, H. Lin, J. Zhang, P. Liang, Z. Lu, M. Wu, Y. Chen, X. Zheng and Y. Qian, "Prevalence and Risk Factors Associated With Self-reported Psychological Distress Among Children and Adolescents During the COVID-19 Pandemic in China," JAMA Network Open, vol. 4, no. 1, p. e2035487, 2021.

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Footnote 73

A. Ruba and S. Pollak, "Children’s emotion inferences from masked faces: Implications for social interactions during COVID-19," PloS one, vol. 15, no. 12, p. e0243708, 2020.

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Footnote 74

R. Lubrano, S. Bloise, A. Testa, A. Marcellino, A. Dilillo, S. Mallardo, S. Isoldi, V. Martucci, M. Sanseviero, E. Del Giudice and C. Malvaso, "Assessment of respiratory function in infants and young children wearing face masks during the COVID-19 pandemic," JAMA network open, vol. 4, no. 3, pp. e210414-, 2021.

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Footnote 75

N. Jones, Z. Qureshi, R. Temple, J. Larwood, T. Greenhalgh and L. Bourouiba, "Two metres or one: what is the evidence for physical distancing in covid-19?," British Medical Journal, 2020.

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Footnote 76

D. Chu, E. Akl, S. Duda, K. Solo, S. Yaacoub, H. Schünemann and C.-1. S. U. R. G. E. (. s. authors, "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis," Lancet (London, England), vol. 395, no. 10242, pp. 1973-1987, 2020.

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Footnote 77

National Collaborating Centre for Methods and Tools, "Public Health Agency of Canada Emerging Science Group: Evidence brief on SARS-CoV-2 virus dispersion distance," 2020.

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Footnote 78

Z. Berger, N. Evans, A. Phelan and R. Silverman, "COVID-19: Control measures must be equitable and inclusive," British Medical Journal, vol. 368, no. m1141, 2020.

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Footnote 79

A. Braunack-Mayer, R. Tooher, J. E. Collins, J. M. Street and H. Marshall, "Understanding the school community’s response to school closures during the H1N1 2009 influenza pandemic," BMC Public Health, vol. 13, no. 1 doi: 10.1186/1471-2458-13-344, pp. 1-15, 2013.

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Footnote 80

A. Bish and S. Michie, "Demographic and attitudinal determinants of protective behaviours during a pandemic: A review," British journal of health psychology, vol. 15, no. 4 DOI: 10.1348/135910710X485826, pp. 797-824, 2010.

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Footnote 81

H. Seale, C. E. Dyer, I. Abdi, K. M. Rahman, Y. Sun, M. O. Qureshi and M. S. Islam, " Improving the impact of non-pharmaceutical interventions during COVID-19: examining the factors that influence engagement and the impact on individuals," BMC Infectious Diseases, vol. 20, no. 1, pp. 1-13, 2020.

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Footnote 82

P. Lunn, C. Belton, C. Lavin, F. McGowan, S. Timmons and D. Robertson, "Using Behavioral Science to help fight the Coronavirus," Journal of Behavioral Public Administration,, vol. 3, no. 1, pp. 1-15, 2020.

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Footnote 83

X. Y. Yang, R. N. Gong, S. Sassine, M. Morsa, A. S. Tchogna, O. Drouin and P. Jantchou, "Risk Perception of COVID-19 Infection and Adherence to Preventive Measures among Adolescents and Young Adults. Children," vol. 7, no. 12, p. 311, 2020.

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Footnote 84

G. Berg-Beckhoff, J. Dalgaard Guldager, P. Tanggaard Andersen, C. Stock and S. Smith Jervelund, "What Predicts Adherence to Governmental COVID-19 Measures among Danish Students?," International journal of environmental research and public health, vol. 18, no. 4, p. 1822, 2021.

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Footnote 85

M. Fendrich, J. Becker, C. Park, B. Russell, L. Finkelstein-Fox and M. Hutchison, "Associations of alcohol, marijuana, and polysubstance use with non-adherence to COVID-19 public health guidelines in a US sample," Substance Abuse, vol. 42, no. 2, pp. 220-226, 2021.

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Footnote 86

S. F. Tapert, G. A. Aarons, G. R. Sedlar and S. A. Brown, "Adolescent substance use and sexual risk-taking behavior," Journal of Adolescent Health, vol. 28, no. 3, pp. 181-189, 2001.

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Footnote 87

J. Cressy, "The roles of physical activity and health in enhancing student engagement: implications for leadership in post secondary education," College Quarterly, vol. 14, no. 4, 2011.

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Footnote 88

L. Fenton, C. White, B. Hamilton-Hinch and R. Gilbert, "The impacts of recreation programs on the mental health of postsecondary students in North America: An integrative review," Leisure Sciences, 2018.

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Footnote 89

K. Young and C. Prematunge, "Evidence Brief on the Risk of COVID-19 and Non-Professional Sports. Emerging Sciences Group Public Health Agency of Canada," 2020. [Online]. Available:

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Footnote 90

L. Waddel and A. Otten, "Evidence Brief of SARS-CoV-2 Risk in Arenas," Emerging Sciences Group Public Health Agency of Canada, 2021. [Online]. Available:

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Footnote 91

J. O'Keefe, "COVID-19 risk and precautions for the performing arts," National Collaborating Centre for Environmental Health, Vancouver, 2020.

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Footnote 92

Public Health Ontario, "COVID-19 transmission risks from singing and playing wind instruments - what we know so far," July 2020. [Online]. Available: [Accessed 12 April 2021].

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Footnote 93

J. O'Keefe, "COVID-19 risks and precautions for choirs," National Collaborating Centre for Environmental Health, Vancouver, 2020.

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Footnote 94

Public Health Ontario, "Singing and playing wind instruments - environmental scan related to COVID-19," 8 January 2021. [Online]. Available: [Accessed 12 April 2021].

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Footnote 95

National Collaborating Centre for Methods and Tools, "What is known about the risk of transmission of COVID-19 within post-secondary institutions and the strategies to mitigate on-campus outbreaks," 16 April 2021. [Online]. Available:

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Footnote 96

C. Anderson, C. Leeson, A. Valcourt and D. Uranjik, "COVID-19 Pandemic: Implications for First Nations Communities in Northern Ontario," University of Toronto Medical Journal, vol. 98, no. 2, 2021.

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Footnote 97

Canadian Paediatric Society., "Supporting a Safe Return to School for Canada's Children and Youth," 23 June 2020. [Online]. Available: [Accessed 09 April 2021].

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