Study updates

September 14, 2020

Researchers and teachers provide initial observations from school simulation study

Researchers and clinicians from The Hospital for Sick Children (SickKids) led a study on August 19 and 20, 2020, looking at the effects of physical distancing, masking, hand hygiene and other health and safety measures for students and teachers returning to school during the COVID-19 pandemic. While formal results are not yet available, the researchers and teachers involved in the study have compiled preliminary observations and key learnings from their experiences running simulated school days.

“Management of the COVID-19 pandemic has been very complex and filled with tremendous anxiety. As health-care providers and parents, we can empathize with the teachers, school staff, school boards and the education sector as a whole, who are now facing a great deal of uncertainty,” says Dr. Michelle Science, Co-Principal Investigator of the study and Staff Physician in the Division of Infectious Diseases at SickKids. “As the school year progresses, sharing key learnings and best practices from simulations or real-world experiences could help enhance everyone’s safety measures. Having the flexibility to adjust these safety measures will strengthen our collective response to COVID-19.”

The simulation included over 190 students and 15 teachers from both public and independent schools. Students of all ages attended the simulations, which included in-classroom learning, lunch, recess and parent/caregiver pick-up and drop-off. All students were required to submit a paper screening tool asking about COVID-19 symptoms at the start of each school day.

The researchers and teachers discussed their initial observations and shared their key learnings with school boards and public health authorities to inform back-to-school planning.

“As the return to school has already started, teachers across the province are likely learning, or have already learned, the same observations we made,” says Dr. Clyde Matava, Co-Principal Investigator of the study, Staff Anesthesiologist and Associate Chief of Perioperative Services, Department of Anesthesia and Pain Medicine, SickKids. “We hope the wide release of these initial findings will foster conversations between stakeholders to share invaluable knowledge about school safety that can only be gleaned from real-world settings.”

The study team is analyzing data and planning a peer reviewed publication in the near future. The initial observations below have not been published in a peer-reviewed journal and are meant to serve as helpful considerations for schools and school boards.


Preparation and planning for school days

Teacher involvement

Teachers played a critical role in the set-up and design of the school days. Their intimate knowledge of classrooms and procedures, combined with their active involvement in the planning process, allowed for smooth and creative implementation of the health and safety measures.

Classroom set-up

The classrooms used during the simulation resembled a typical public school classroom (i.e. 32 feet by 24 feet). With these room sizes, it was not possible to maintain a two-metre distance between students and accommodate more than 12-15 students in the class even with the desks against all four walls.

Start of the school day

  • There was crowding at entry points even with staggered class starts and fewer students than at most public and private schools.
  • The entry process took longer than expected. This involved collection and inspection of a paper screening tool, staggered entry by classes, hand hygiene, and application of a liquid indicator that was part of the study procedure.
  • Having a designated staff member (e.g. supervisory duty teacher at an entry point) to indicate to teaching staff when their class could proceed with entry helped for smoother transitions that provided sufficient distancing.
  • During school

  • Students were unsure of what to do with their masks during recess (for example, masks secured around wrists became soiled). Several children in the younger grades needed new masks provided throughout the school day.
  • After school

  • Several parents wanted to check in with the teacher at the beginning and end of the school day and were often not wearing masks because of the outdoor pick up. As a result, it was difficult for teachers to maintain distance while supervising the children and support a conversation with parents.
  • On-site staff congregated in shared spaces like workrooms and offices.
  • Considerations

    • Classroom set-up:

      • Remove any non-student related furniture
      • Utilize all available space (including desks against walls and at the back of the class)
      • If class sizes are not reduced, alternative classroom set-ups should be explored to promote physical distancing (e.g. small cohorted groups within classes)
    • Staggering of start dates will facilitate reduced crowding as students adapt to new entry processes.

    • Ongoing staggering of start times will likely be required at most schools to avoid crowding on entry, especially in the presence of an active screening strategy.

    • A process is needed for late students who miss entry with their cohorts.
    • All available doors should be used for entry and exit to reduce crowding.

    • Routine on-site screening at entry points will require additional time and is likely not feasible without multiple screeners.
    • A clear process should be developed for mask storage during recess and communicated to staff, families, and students. Our group recommends;

      • Store masks in a labelled, clean and dry bag that can be kept on the student during breaks (e.g. in their pocket or fanny pack)
      • Unprotected mask storage (e.g. lanyards or wearing as “wristlet”) may lead to soiling and the need for mask changes.
      • If lanyards are used, ensure there is a safety release / breakaway mechanism (to reduce strangulation risk) and they should ideally be removed on the playground.
    • A process for teacher communication with parents/caregivers should be developed and communicated in advance of school to limit non-essential in-person discussions which may lead to crowding and delayed school dismissal.

    • Staff involved in the direct supervision of students should be encouraged to minimize their time (outside school hours) inside the school building, especially in shared spaces like staffrooms and department workrooms.

    • For staff members not directly involved in the physical supervision of students, consideration should be given to working off-site to avoid unnecessary congregating with other staff.