Why the Ford Government Deserves an “F” on their approach to Safe Transportation of Students in the era of COVID19 in 2020/21.

I was surprised to see very little of yesterday’s announcement from the Ontario government devoted to the safe bussing of children. There was well deserved focus on physical distancing in high school (albeit 1 m, instead of 2m), masking all those children from grade 4 on, medical grade masks for teachers, while encouraging younger children to wear masks if possible. Yet, little was voiced about the 10–60 minute bus ride many rural and urban children endure each day. Canadian students probably spend more time on the school bus than in most countries.

In Ontario, school boards award contracts to private school bus companies. That is, education tax dollars are used to contract out student transportation. The lowest bid is the usual winner. FirstStudent Inc is the largest school bus company in North America, and has the majority of contracts in Ontario. They are advertising a “Start Safe” program explained on their website. They recommend a once-monthly school bus disinfection with Zoono-Z71, claimed to be a long-lasting, non-toxic disinfectant with a 99.99% effectiveness against COVID19. Health Canada is evaluating their claim. Stickers are to be provided, to indicate seats being blocked for social distancing. Social distancing on buses means some children will have to find other means of transportation. I imagine that would not be a popular talking point on the launch of the Ministry of Education’s School Re-Opening Strategy.

Ultimately, the Ontario Ministry of Education is responsible for safe student transportation. The principles outlined by experts at SickKids Hospital in “COVID19: A Guide for School Re-Opening” include screening of symptomatic individuals, physical distancing, hand hygiene, masking, cleaning the environment, protection of at-risk persons, and considerations for those with medical/physical/mental/behavioural complexities. There is no reason to abandon those principles on the school bus though transportation was not explicitly addressed in this document.

The Ministry’s website document: “Guide to reopening Ontario’s schools” fortunately mentions funds for cleaning school buses and PPE for drivers in their executive summary. Under the heading “Transportation”, the following are mentioned as strategies but left to each school boards discretion:

• “Active forms of travel (for example, walking and cycling) and private transportation by parents and caregivers, are encouraged where possible, to ease pressure on transportation demand.”
• “…school boards may be required to increase the utilization of buses beyond 1 student per seat and operate closer to capacity” (contrary to their archived June document which emphasized this strategy for physical distancing). Maximum capacity on a regular school bus is 72 children grade 8 and less, or about 46 high school students. Some buses are smaller. How many students is too much?
• A mandatory mask policy, as in schools is mandated for grades 4–12 students. It is suggested that masks will make up for lack of physical distancing, which is contrary to the guidance provided in the high school classroom (1 m distancing). Elementary classes sizes are not restricted, so physical distancing has been abandoned as a public health strategy. I imagine the hope is that a number of parents will opt for online learning.
• “Students should be assigned seats and a record of the seating plan should be kept to assist with contact tracing in the case of a student or driver contracting COVID-19. Students who live in the same household or are in the same classroom cohort should be seated together.” I would note that an individual bus driver would commonly travel to a few schools in a morning and in the afternoon. Is it feasible for a driver to manage multiple seating charts and be on time for bus stops? For grade school students, I suspect this is a bit of a magical thinking. It’s a challenge to keep them seated at the best of times. Did the authors consult actual school bus drivers or try to understand rural and city bus routes?
• “Medical masks and eye protection (i.e. face shields) will be provided for school bus drivers, school bus monitors and student aides.” I would question why high school students spending significant time on the bus do not need eye protection in the absence of distancing? Recently, Dr. Anthony Fauci suggested CDC guidance may soon recommend eye protection. Researchers from McMaster University demonstrated in a thorough systematic review, a reduction in coronavirus (SARS, MERS, SARS-CoV-2) infections among those who wore eye protection. Airborne spread is increasingly recognized as a potential, though uncommon, mode of spread especially in poorly ventilated environments (as in a school bus?).
• Disinfecting protocols are supported for high touch surfaces at least twice daily. Alcohol based sanitizer should be available on vehicles. All good.
• “Where possible, the seat directly behind the school bus driver should remain empty to maintain physical distancing”. Are bus drivers worthy of protection or not? Apparently, plexiglass shields and other barriers have been prohibited for safety reasons. Distancing is important for drivers who are often seniors, or late middle aged individuals.
• “Windows should be opened, when feasible, to increase ventilation.” School buses have poor ventilation. This approach will pose problems during inclement weather, and during the winter of course. There is a single fan at the front of the bus. A battery powered fan inserted in a rear window could potentially greatly improve ventilation, but would it be too costly? Perhaps there are superior solutions to improve ventilation. Otherwise, should capacity be reduced in the winter months?
• “School boards should support accommodations for immunocompromised and otherwise medically vulnerable students, and students with special transportation needs (e.g., arrange separate vehicle, assign seating at front of school bus).” Of course, this is standard for most school boards presently. However, Special Needs Bus Drivers are at higher risk while operating these buses. Students with developmental disabilities, cerebral palsy, for example, may not be able to wear masks. The bus drivers require medical grade personal protective equipment including gowns, goggles and possibly N95 masks. Very close contact is required to bolt wheel chairs in place and unlock them at each stop. Full body garb with hoods would not be unreasonable. Training for infection control by public health nurses will be necessary.
• “Training, where appropriate, to support school bus drivers, school bus monitors, and student aides should be provided to ensure that health and safety measures are understood, followed and enforced.”
• “Student transportation service providers should also consider the Health and Safety Guidance During COVID-19 for Student Transportation Employers released by the Public Services Health and Safety Association.”

The PSHSA guidelines referenced above, refer to the importance of physical distancing of 2 metres between students. Partitioning off seats with decals or tape is suggested to limit close contact, and to indicate to students where they should not sit. This underscores a major problem with Ontario’s Ministry of Education recommendations: They are in conflict with the guidelines from Canada’s Chief Public Health Officer, Dr. Theresa Tham.

The Ministry recognizes in their document that ventilation in school buses is poor but choose not to address it beyond an opening a window.

They recognize that the safety of the bus drivers is a chief concern but do not mandate distancing around them.

They fail to mandate the most important public health measure, physical distancing between students. In the setting of questionable to poor ventilation, distancing becomes more crucial in my opinion.

Ideally, infectious disease specialists will be consulted to provide school boards greater guidance. In the interim, it is reasonable to for school boards to consider the following recommendations:

1. Inform parents that school bus capacity will be greatly limited in 2020–2021. Those who absolutely require school bus transportation should call to request a spot.
2. Implement physical distancing as directed by Dr. Theresa Tham and the Public Health Services and Safety Association (PHSSA). Compromising on distancing, when ventilation is poor, is an unnecessary risk. One student per seat (unless siblings), or perhaps two small children per seat with a taped barrier in between, seems reasonable. I note this does not approximate the 2 m distancing recommended by (PHSSA) since the seats are about 18 inches apart, but is far better than operating buses as usual, as a suggested possibility by the Ministry of Education. Are private school bus companies likely to accept additional liability beyond the federal recommendations of the PHSSA?
3. Students and parents should complete the daily self-screen before getting on the bus. This should be confirmed by the bus driver before boarding.
4. The seat behind the bus driver must always be vacant in keeping with PHSSA recommendations for distancing.
5. Students must sanitize upon boarding the bus.
6. All students should be masked while on the bus. Young children can, and do wear masks. Older children can assist them if necessary.
7. School boards should plan for significant driver attrition since much of their workforce are seniors. Additional training and hires will be necessary early in the school year.
8. Innovations to improve ventilation in school buses should be addressed by school bus companies immediately. Opened windows will suffice until temperatures drop.
9. Encourage the use of eye protection among high school students.
10. Arrange public health nurses to educate school bus drivers on proper use of personal protective equipment and the sanitization of face shields or goggles.

Many of the Ministry’s recommendations are positive and should obviously be mandated. Parents should be fully informed of each school board’s approach to school bus procedures and risk mitigation well in advance of the start of school, since the Minister of Education, Mr. Lecce, elected to leave these measures to the discretion of each school board.

So the F is deserved since: 1. Infectious disease specialists apparently did not advise the Ministry on safe student transportation, 2. The Ministry failed to mandate many of the important safety procedures it mentioned, rather offloading those decisions to individual school boards to allow for maximal student transportation, and 3. The Ministry strayed from the recommendations of the Chief Public Safety of Officer of Canada, Dr. Theresa Tham, and by “Health and Safety Guidance During Covid-19 for Student Transportation Employers” by the Public Services Health and Safety Association.

Note: Correction — In an earlier version of this article I had mistakenly described the Public Services Health Safety Association as a Federal organization. It is not, rather a branch of the Ontario government. The link to the document referred to by the PSHA has been removed…no surprise.