Parents and children wanting to know when COVID-19 vaccines could roll out to Canada’s youngest people recently got a glimpse at the answers.
Dr. Supriya Sharma, Health Canada’s chief medical adviser, said it is “likely that Pfizer, if all the data is fine, may be the first” vaccine that children and teens could receive.
Pfizer and BioNTech said in a media release on Wednesday that their COVID-19 vaccine, BNT162b2, is safe with “demonstrated 100 per cent efficacy” in preventing the disease in teens aged 12 to 15.
The data hasn’t been peer reviewed or scrutinized by regulators like the U.S. Food and Drug Administration and Health Canada.
In the trial of 2,260 adolescents, there were 18 cases of COVID-19 in the group that got a placebo shot and none among those who received the vaccine.
Side-effects were similar to those reported in clinical trials in adults, such as pain at the injection site, headaches, fever and fatigue.
WATCH | Pfizer’s early data on vaccine for kids:
Pfizer-BioNTech says its vaccine is safe and showed 100 per cent efficacy in a clinical trial of 12- to 15-year-olds. Health officials say more data is needed, but parents are optimistic about the results. 2:03
Sharma said Health Canada will review Pfizer-BioNTech’s COVID-19 vaccine data on younger teens “in a couple of weeks.” Full data, including on children aged six to 12, is expected in months.
Any approvals will only come after the regulator checks the data for safety, efficacy and quality.
Pfizer’s vaccine has been cleared for people as young as 16 in Canada.
Dr. Noni MacDonald, a pediatric infectious diseases specialist at Dalhousie University in Halifax who researches vaccine safety, said Pfizer’s research is a “bridging study.”
In a bridging study, researchers check if antibody and cell-based immune responses are equivalent to what’s seen in adults. For Pfizer, they were.
“The results are really very encouraging,” MacDonald said.
Protection for all Canadians
Moderna is also conducting a clinical trial in Canada for children aged five to 11. The results are expected early in 2022. The company also launched a trial in those aged six months to less than 12 in the U.S. in March.
Johnson & Johnson, which recently won approval for its vaccine in adults in Canada and the U.S., expanded its Phase 2 trial for those aged 12 to 17 and plans to include younger children.
But it’s only when vaccines roll out in the real world to children with diabetes, heart disease and other underlying conditions that answers on effectiveness will be clearer.
“We want to protect everybody in our community, even those who cannot be immunized or will not respond to the vaccine,” MacDonald said. “To do that, we need children, we need teenagers, we need young adults, we need middle-aged adults and we need older people.”
Alyson Kelvin, an assistant professor at Dalhousie working on COVID-19 vaccines at the VIDO lab in Saskatoon, said she’s excited about how the vaccines could help children return to school and sports.
“Children can be infected with the virus and pass on the virus,” Kelvin said. “Even though we might not see clinical disease in kids or the clinical disease might not be as severe as in adults, it’s really important that children are not able to be part of the transmission chain.”
MacDonald hopes vaccines could be ready for younger teens by September, in time for mass immunization programs in school.
The vaccine has also been authorized for emergency use in Americans who are aged 18 and older.
The Moderna vaccine is made from messenger RNA, or mRNA, a type of genetic material that is used by cells to translate instructions found in DNA to make proteins.
In this case, the instructions tell a human cell how to make a stabilized version of the spike protein for SARS-CoV2. That introduces the protein into the body so immune cells can learn to recognize it and produce antibodies against it.
In a separate study that began in December, Moderna is also testing mRNA-1273 in adolescents between 12 and 18 years old.
The latest study is being conducted in collaboration with the National Institute of Allergy and Infectious Diseases and the Biomedical Advanced Research and Development Authority.
New research published in the Canadian Medical Association Journal (CMAJ) found that one-third of children who tested positive for the virus that causes COVID-19 had no symptoms, but in those that did, loss of taste/smell, headache, fever and nausea/vomiting were most strongly associated with positive cases.
Other flu-like symptoms — including cough, runny nose and sore throat — were the most prominent symptoms in positive cases, but the study suggests they couldn’t be used to accurately predict which cases were positive because they were also most prominent in cases that tested negative.
The study, published Monday, was by researchers at the University of Alberta who analyzed 2,463 test results from children in the province between April 13 to Sept. 30. They compared symptoms of those who tested positive (1,987) with those who tested negative (476).
Eight per cent of kids with positive COVID-19 tests had loss of taste/smell, versus one per cent of kids who tested negative. And four per cent had nausea or vomiting, versus less than one per cent of those who tested negative.
Headache was a symptom in 16 per cent of positive cases, compared to six per cent in negative cases, and 26 per cent of positive cases had fever, compared to 15 per cent of negative cases.
Symptoms in hospitalized kids differ
Dr. Finlay McAlister, one of the authors of the study, says those symptoms were associated more with having coronavirus rather than some other virus.
He said cough, runny nose and sore throat were equally common symptoms in kids who didn’t have coronavirus but may have had another virus.
Symptoms of fever or chills, cough and runny nose in this study (19 to 26 per cent) were less frequent than in studies conducted in hospital settings. The authors of the study suggest that was because this was a community-based cohort and cases of disease were likely more mild than those seen in hospitals.
Children aged four and younger were more likely to test negative, and teenagers (ages 13 to 17) were more likely to test positive.
Kids Help Phone, the charity that offers 24/7 counselling services to young Canadians in distress, needs to listen to the concerns of its stressed staff if it truly wants to help callers, say three current and former counsellors.
Demand for Kids Help Phone’s services has been on the rise, with calls and text messages surging since the COVID-19 pandemic began.
But the counsellors who spoke with CBC’s Go Public say handling the increased demand is even more difficult because of the micromanagement and unreasonable demands of supervisors, which have taken a toll on counsellors’ ability to do their job properly — and on their own mental health.
They said the service is being run like a corporate call centre, and counsellors are under pressure to account for how every single minute of their workday is spent via a software tracking system.
“It was like a production line,” said one former counsellor. “Like, we need another target, we need to hit three million calls. I mean, we’re not in sales. I’m helping people.”
WATCH | Counsellors speak out about working conditions at Kids Help Phone:
Some current and former staff at the 24/7 national helpline say it is being run like a corporate call centre, not a counselling service for young people in crisis, which is causing high employee turnover because of burnout. 2:09
CBC News has agreed not to publish the names of the current and former counsellors who were interviewed, as they fear that speaking out against the practices of an organization as well-known and important as Kids Help Phone could harm their future employment prospects.
They revealed how Kids Help Phone measures the performance of counsellors based on what it calls key performance indicators (KPIs). Their job performance is tracked, with percentages, for things like how many calls they failed to answer, how often they weren’t ready to answer a call, and what percentage of their time was devoted to self-care.
Supervisors require an explanation from counsellors if their KPIs don’t match the organization’s performance targets.
Time to debrief with colleagues after upsetting calls — something they were able to do in the past in order to recover and get into a proper frame of mind for the next call — is now strictly limited, the counsellors said.
Pressure and burnout
Kids Help Phone has provided assistance to millions of young people in its 30-year history, including counselling victims of abuse and helping to prevent suicides. It also provides a caring listener to young people who just need to speak anonymously to someone about their troubles.
The charity employs 182 professional counsellors in Vancouver, Toronto and Montreal, with 50 more coming on board by the end of the year, thanks to additional federal funding in response to the pandemic.
Those who contacted Go Public said the addition of new staff hadn’t done much to reduce stress, as the micromanaging continued. Alerting supervisors, management and their union to the problems didn’t lead to any significant changes either, they said, even though the stressful working conditions counsellors face affect the quality of their work and their ability to help kids in need.
But after Go Public contacted Kids Help Phone to tell them that several counsellors had been in touch, the charity’s chief youth officer said changes will be made.
“Our counsellors are courageous, kind and top professionals,” said Alisa Simon, who described herself as the executive most in touch with workplace issues at the charity. “If we miss something, we will make it right; including changing guidelines to better meet their needs.”
No specific details of how guidelines would be revised, or when, were included in the statement.
In a previous statement to Go Public, Kids Help Phone said it has added more support for front-line staff over the past eight months and intends to add even more, including mindfulness programs, extra days off in summer and “added time to decompress and debrief.”
The charity also said it surveys staff to hear how they are doing.
However, a current Kids Help Phone counsellor, referred to as Natalie for the purpose of this article, says stress leaves are common and turnover is high.
“We can’t really give the proper support if we’re burning out,” she said.
Another former counsellor, who will be referred to as Ashley, said the organization’s intense focus on efficiency metrics, which was introduced in late 2019, is a distraction during crisis calls.
“That’s a lot of pressure to have in the back of your head when you’re trying to be present talking to some of these kids,” she said. “It takes away from the main focus of what we’re trying to do.”
Natalie said supervisors have even sent messages to counsellors over the company’s internal chat system during lengthy calls to ask what’s taking so long.
“That can bring some anxiousness and nervousness,” Natalie said.
“You think, ‘Oh, the manager is noticing how long I’ve been on the phone,’ and it really takes you out of the call, because now you’re worried that the manager is watching and you’ve been on too long. It can ruin the work you’re doing.”
Union not helping much, say counsellors
Kids Help Phone workers are represented by the Ontario Public Service Employees Union, but the counsellors who spoke with CBC News say complaints to the union haven’t led to meaningful action.
“The union has said for us to keep trying, to keep giving suggestions, to document the problems,” Natalie said. “And that’s not enough. I think that their method is just to wear management down. But we’re worn down.”
Go Public reached out to the union for comment but has yet to receive a response.
Before the focus on time management and efficiency was introduced late last year, Kids Help Phone had been a great place to work, said Jacques, a former counsellor.
“When I first started, I told my friends, ‘I’m going to retire from this place, I love it,'” he said. “The training was fantastic.”
Ashley said she also used to love the work.
“It was amazing to be able to help some of these kids,” she said.
The counsellors said they didn’t have a problem with the charity using a software program to track their work activities through a system of codes. They could still manage their own workflow and weren’t chastised for missing time-management targets, they said.
But once the new operational guidelines were introduced last December, the charity started to measure counsellors’ performance on a monthly basis, providing percentages to indicate their adherence to a strict schedule that dictated precisely how much time they were to spend on various activities and when they could take breaks.
Bathroom breaks counted as ‘self-care’
On one occasion, before the pandemic hit and counsellors started working from home, Jacques said his supervisor confronted him after returning late from break.
“I got told, ‘You went a minute over your lunch. What are we going to do about it?'” he said.
A Kids Help Phone operational guide, provided to employees, was obtained by CBC News. It says time is allowed for self-care, but that it should amount to no more than five per cent of a counsellor’s “log in time averaged over the course of a month,” or, for example, 30 minutes during a 10-hour shift.
The document also specifies the downtime is intended to promote wellness, and suggests it can be used to get a coffee or tea, or to use the washroom.
Jacques confirmed this is how it works.
“I can’t even go to the washroom without having to justify to someone why I spent two minutes off the phone?” Jacques said in exasperation.
The counsellors who spoke with CBC News said the unpredictable nature of the calls they receive demands a level of flexibility in their workday, but supervisors don’t seem to appreciate that, insisting instead the schedule be strictly followed.
Danielle van Jaarsveld, who teaches in the organizational behaviour and human resources department at the University of British Columbia’s Sauder School of Business, and has studied call centres in the U.S., Europe, China and Canada, said it appears Kids Help Phone is compounding the stress of an already stressful job.
“The issue with this type of monitoring is that it really contributes to the employee emotional burnout,” she said. “And when employees are burnt out, they really can’t perform at their best.”
She said employee time-tracking systems like the one used at Kids Help Phone are not uncommon, but are more suited to call centres that deal with “shorter, simpler transactions,” as opposed to lengthy counselling sessions.
“What I tend to see in call centres where the interaction involves emotions is much more discretion being given to the employees with respect to break time.”
Believe it when they see it
When told that Kids Help Phone said it plans to change the time-management rules, Natalie said she is skeptical about her employer’s motivation.
“They say they have our well-being at the front but they have said that before and nothing changed,” she said. “I do believe that if this time has a different result, it is only because they are worried about their reputation and not us.”
Nonetheless, she and the other counsellors who spoke with Go Public said they remain hopeful that the problems at the charity will be solved. They said the mental health support Kids Help Phone offers its callers is more important than ever.
“I think the people that are higher up are not understanding the reality of the front line,” said Jacques. “We need more autonomy to say, ‘These are my limits right now.’ And that is really not that much to change when you think about it.”
Submit your story ideas
Go Public is an investigative news segment on CBC-TV, radio and the web.
We tell your stories, shed light on wrongdoing, and hold the powers that be accountable.
If you have a story in the public interest, or if you’re an insider with information, contact email@example.com with your name, contact information and a brief summary.
All emails are confidential until you decide to Go Public. Follow @CBCGoPublic on Twitter.
The new regulations feature a shorter list of symptoms that would require a child to be tested for COVID-19. The province said the new rules reflect the latest evidence and were made in consultation with pediatric infectious disease experts.
“This will ensure that our children are able to attend school or child care as much as possible while minimizing the risk of COVID-19 transmission,” said Ontario’s Associate Medical Officer of Health Dr. Barbara Yaffe.
Notably, children will no longer be removed from school or child care and advised to go for testing if they have a runny nose, headache, sore throat, fatigue or diarrhea. Children displaying any one of those symptoms will now be asked to go home for at least 24 hours and return only “when they feel well enough to do so.”
However, if a child has two or more of those symptoms, they will be asked to isolate and contact a health-care provider for further advice.
Those symptoms are “commonly associated with many other illnesses,” Yaffe said.
Children experiencing a fever, persistent cough, chills or a loss of taste or smell will still need to isolate and get medical advice, which includes the possibility that a child may need to be tested for COVID-19.
Dr. Yaffe said the updated regulations will give parents and family doctors a greater ability to assess a child’s health. In some cases a health-care provider may be able to provide an alternate diagnosis, bypassing the need for COVID-19 testing entirely.
“Schools and daycares should not be requiring a negative COVID test; in fact, they shouldn’t even require a doctor’s note,” Yaffe said during a Thursday news conference.
Abdominal pain and pinkeye have also been removed from the list of possible COVID-19 symptoms entirely.
‘Almost all of them had a runny nose’
Toronto child-care operators said they had been struggling for weeks under the previous rules.
Leigh Anne Jacques, the co-owner of Beaches Montessori School, said more than half of the children at her centre have been either sent home or barred from attending since the school reopened in September.
“That’s a really high number of children to be excluded from school for illness,” said Jacques.
“Unfortunately, in our toddler classroom, almost all of them had a runny nose in the first couple weeks of school.”
Amy O’Neil, director of Treetop Children’s Centre, also raised concerns about the previous screening policy, saying that it burdened parents by requiring them to take time off work and take their child for testing.
O’Neil estimated that her centre has also sent home around half of its children over what she would consider mild symptoms. She described spending up to three hours on the phone per day calling Toronto Public Health, the Ministry of Health and the parents of symptomatic children.
“Typically in September we would never be calling parents unless symptoms were really bad,” she said. “In child care we’re very used to runny noses, coughs, diarrhea, the usual childhood symptoms.”
Education Minister Stephen Lecce indicated last week that the province would consider revising its list of symptoms requiring a COVID-19 test after a similar move by British Columbia health officials.
Nerissa Crichlow of Toronto has a lot of unanswered questions about what school will look like for her twin daughters in September.
“First and foremost, are they going to be splitting up the classes? What is that going to look like? Are there going to be testing measures in place?”
She describes herself as “very concerned” about the risk of her seven-year-old daughters, Mila and Norah, contracting and bringing home the coronavirus if in-person classes resume in the fall.
“I really need a good understanding of what the protocols are going to be. I’m asthmatic, my daughter is asthmatic, my father is asthmatic, and my mother has lung issues,” she said.
“For me, it’s really important that the schools have some testing involved, because we are all susceptible to the virus, more so than others.”
Crichlow has plenty of company among Canadian parents who have questions about the looming school year, but the latest research shows young children are at low risk of getting or spreading the coronavirus that causes COVID-19, and that missing school can have long-term costs for a child’s well-being.
Dr. Nisha Thampi understands parents’ reticence about the return to class. The medical director of infection prevention and control at Children’s Hospital of Eastern Ontario in Ottawa is both a pediatric infectious disease physician and a mother.
She said she’s been encouraged, though, by recent study results that give more insight into children’s risk of contracting the illness and of spreading it to others.
“It is with more information around the risk of transmission and infection that we can inform the policies for school setting and other community settings,” said Thampi.
A large study from South Korea, published by the Centers for Disease Control and Prevention in the U.S., found that children nine and under infected others in their households just 5.6 per cent of the time, while children 10 to 19 spread the virus at the same rate as adults, nearly 19 per cent of the time.
And research continues to show that illness is usually mild in children.
A recent meta-analysis of 550 COVID-19 cases among children under 18 in China, Italy and Spain found just nine children had a severe case. One, who died, had underlying conditions.
Parents must be ‘partners in care’ to prevent spread
“There’s good data that shows in the majority of cases, a child with COVID-19 has a symptomatic adult in the home who is also COVID positive,” said Thampi.
That means some of the power for controlling the spread of illness within schools hinges on parents acting as “partners in care,” teaching their kids about good hand hygiene and making sound decisions about their own physical distancing practices, she said.
While it made good sense to shut down schools at the beginning of the pandemic when we were just learning about COVID-19, we now have an opportunity to learn from other parts of the world that have reopened schools with new safety protocols in place, she said.
“I support families who are concerned about schools not being a safe place to return to, because I would suggest that a pre-pandemic school environment did not have the strategies in place to minimize infection spread,” she said.
One issue, she said, was that many parents faced work pressures that made it difficult to keep sick children at home.
Working from home isn’t possible for all jobs, but the pandemic has shown it is an option for many working parents. That, combined with a new vigilance around respiratory symptoms, may help establish new standards for keeping sick kids home from school.
“I think we will be returning to a school setting so long as the right policies are in place — a school setting that is safer in terms of infection transmission risks and that offers opportunities for learning, socialization and, importantly, peer-to-peer learning and development,” Thampi said.
That could mean measures such as spreading kids apart from one another in smaller groups, training children on hygiene practices in school and doing some learning outdoors when weather permits, she said.
Now that children have been without the structure of school for many months, it’s become apparent that eliminating all risk of school-based transmission comes at a cost, said Thampi.
Getting kids back to class between waves
That’s a point Dr. Michael Silverman, chief of infectious diseases at London Health Sciences Centre and St. Joseph’s Hospital in London, Ont., wants to make clear.
“So many times I hear, ‘Well, you can’t be too careful,’ without recognizing the risks of being home,” he said.
The research that’s not getting enough attention these days are the studies on the repercussions of students being out of class, he said.
“If they miss school, there’s long-term impact on their cognitive development, on their social development and their overall ability to function in society.”
Of course, all children will be at a similar disadvantage because of school closures, but the impacts will still be there, he said.
A study from UNICEF Canada found that the COVID-19 pandemic is having an unprecedented impact on the lives of children and youth, citing disrupted routines and loss of education and other resources. The organization is calling on governments to “deliver new crisis mitigation measures” because children “cannot wait months or years to return to school.”
Given that children under 10 pose little risk of infection transmission to others, it makes sense to return their cohort to class, said Silverman.
“If they’re the least likely to get sick, they’re the least likely to transmit, and they do worse with distance learning, the priority should be at least the very young children should be able to get back to school,” he said.
As September approaches, teacher unions are asking for clear plans for safely reopening schools. The Ontario English Catholic Teachers Association, for example, has called on the provincial government to give direction to school boards about their responsibilities to ensure the safety of students and staff.
Silverman points out that most infectious disease experts anticipate a second wave of the illness will come.
“If we don’t take advantage of the time when we’re at a relatively low level of transmission, when another high level of transmission comes … and then we close the schools again, there will be an extremely long period of time with no education.”
Silverman said he believes the choice should remain with parents as to whether their kids learn in the classroom — with best practices for infection-control in place — or from home.
“What I’m advocating is that we should not close all schools and take away all parents’ choice. That parents should be able to make educated choices on behalf of their children as to what they feel is best for their family.”