OTTAWA -- Ottawa's associate medical officer of health says understanding and keeping to the "social bubbles" of no more than 10 people will be a key component of keeping COVID-19 transmission low as we approach the fall.

Dr. Brent Moloughney made the comment while speaking to reporters Wednesday.

It follows a statement from Ontario Premier Doug Ford on Tuesday that Ontarians will likely need to stick to smaller social circles for the remainder of 2020.

Dr. Moloughney says the social bubble system, wherein you agree to treat a small number of additional people outside your household as if they are members of your household and vice-versa, is one of the strategies for reducing transmission is least understood.

"The social circle piece is something that we will need to continue to reinforce because I think there's the opportunity for misunderstanding," he said. "The issue is that there's a reciprocity. There is an agreement amongst all the people in a particular circle that they are only going to treat each other in that way. You can't belong to more than one circle."

He gives the example of two families of five living next door to each other.

"We're going to come together, the kids are going to play together, the adults are going to socialize and we're going to treat each other as though we're all part of the same household, and we're going to physically distance with everybody else outside our ten," he said.

"That's the key part for this to work. It's not, 'I'm part of this bubble today and tomorrow I'm part of another bubble,'" he said. "Then, the 10 becomes 20, becomes 30, becomes 40, and just becomes an opportunity for increased transmission."

Dr. Moloughney said in his opening remarks that large gatherings were reported over the long weekend. Ottawa also saw a significant rise in the number of COVID-19 cases linked to indoor gatherings of people outside of these bubbles, without distancing and mask use.

He says he understands the need to socialize, but is encouraging people to continue physically distancing, wearing masks, and frequently washing their hands when socializing outside their strict social bubble of up to ten people. Smaller social bubbles are also encouraged.

"Ten is the max but it doesn't mean you need 10," he said. "If you live alone or with a roommate and you have maybe two or three other people that you agree will stay in just that one bubble, then that's wonderful because the more we can restrict the number of close contacts we have, the better."

What about schools?

As September approaches, there have been questions about how social bubbles will work once school begins. Ontario's plan to reopen schools includes full class sizes in elementary levels, leaving many to wonder how to maintain a household bubble when their young child is in a classroom of more than 20 other students plus a teacher.

Dr. Moloughney said it will be a balancing act between keeping students in cohorts of just their class and a teacher as much as possible, combined with as much distancing as possible, mask use whenever possible, and hygiene, including keeping kids and staff home if they're sick.

"I think those will all contribute to making schools as safe as possible but, at the same time, we need to prepare for and plan for there to be cases," he said. "In a city the size of Ottawa, there will be cases in schools. We will have the processes in place to investigate and control transmission if, and when, that occurs."

Ottawa Public Health is working with local school boards and with the Ministry of Education on how best to reopen schools. Dr. Moloughney said the experiences over the summer with day camps and childcare centres have provided possible examples of ways to manage schools in the event of a case; however, deciding whether to close a school will be determined on a case-by-case basis.

For example, a recent case in an employee at the Foster Farm Community Centre has forced a suspension of all day camp activities for 14 days. Dr. Moloughney said, in the case of a school, that may not be necessary.

"In a day camp or a daycare where there might only be one cohort or a small number of cohorts, then perhaps that facility will close temporarily to determine if there's spread from one cohort to another. I think, with schools, depending on the size and the context, there will be discretion," he said. "Think of a high school with 1,500 students. You may not need to close the entire facility if you think the risk is only to one cohort or two cohorts. Those at highest risk would be in self-isolation and then we assess risk beyond that cohort and react accordingly."

Reopening schools is necessary to maintaining the overall health of the community, Dr. Moloughney said.

"We have to balance the risk of COVID-19 transmission with mitigating other harms to the wellbeing of children, youth, families, and school staff," he said. "Enabling a return to school this September that is as safe as possible is crucial not only for childhood development and academic achievement but for the health and wellbeing of the entire community."