The decision to reopen schools amid the Covid-19 pandemic has been met with mixed reviews as parents stress over the safety of their children. Dr Sheri Fanaroff, MBBCH MFamMed FCFP, a member of The Gauteng General Practitioners Collaboration, weighs in on how safe it is to send our little ones back to the classroom.
On 8 June, schools across the country opened with mixed feelings from parents, teachers, learners and the media.
As GPs, we engage with many anxious parents worrying about their children leaving the safety of the cocoon they have been in at home for the past eight weeks, and I would like to address some of the medical facts that should impact on parents’ decisions around sending their children back to school.
When making this decision, these are the factors that should be considered:
1. RISK TO CHILDREN OF DISEASE AND DEATH
Large studies from around the world show that children are much less likely to acquire Covid-19 than adults. Less than 4% of total infections worldwide are in children under 19 years.
Similarly, the mortality (death) rate in children is exceptionally low around the world. As an example, in Italy, out of nearly 32 000 deaths reported on 25 May, only four of these (0.01%) were in children under 19 years.
In South Africa up until 15 June, there have been three deaths (0.2% total) reported in children 0 to 9 years, and five deaths in children 10 to 19 years (0.3% total) - at least half of which had severe comorbidities. These are similar to figures in children from countries around the world.
2. RISK OF TRANSMISSION OF VIRUS FROM CHILDREN TO ADULTS
Evidence from around the world consistently shows that although children were initially thought to be super-spreaders (based on the influenza model), this assumption was incorrect, and in fact children are rarely the primary sources of infection in a household or population.
Children are much more likely to be infected by adults in their own homes or at social gatherings where adults are present.
Infections are more likely to be transmitted between parents congregating at schools and through social gatherings outside of schools - these need to be avoided.
3. SOCIAL AND ECONOMIC COSTS OF KEEPING CHILDREN AT HOME
With many parents going back to work in Level 3 of lockdown, we need to consider the benefits that children of all ages derive from going to school - socially, psychologically, educationally, and nutritionally.
The social isolation of extended lockdown can create anxiety, depression, inactivity and other problems in children, and the longer children stay out of school, the more difficult it is to get them back.
1. Is it safe to go bask?
Government regulations stipulate that schools must be sanitized and specific protocols put in place to ensure the safety of learners and teachers.
The crucial points for safe return to school include the basic principles of physical distancing, hand hygiene and the wearing of masks.
Screening before entering campus, limited numbers of children in classrooms, the spacing between desks, rigorous sanitisation, wearing of masks, and playground supervision are just some of the considerations that should be taken into account.
Schools also need policies around what to do when a teacher or child gets infected, and around sick children staying at home.
If all the recommendations are followed, we do believe that it is safe for children to go back. In schools where there is often poor sanitation and overcrowding, these measures are much more difficult to implement but can be achieved with effort and imagination (eg. classes held outdoors or in larger halls with doors open).
Remember that many infected children are completely asymptomatic, and we have to assume that everyone around us is potentially carrying the virus.
2. My child is immunocompromised or has asthma. Should I rather keep them at home?
There is still not enough hard evidence in children as to which comorbidities might be more dangerous in children affected with Covid-19.
Children with underlying cardiac disease; severe lung disease; immunosuppression like HIV or cancer; those on chemotherapeutic or immunosuppressive medications; that with severe uncontrolled asthma, diabetes, cystic fibrosis; and those with post bone marrow transplants all need to be individually assessed for risk versus benefit.
There is no blanket decision that is correct for all of these children.
Even some in these categories might be able to attend school with proper cautions in place. Remember that children who fall into these categories would always be at risk for infectious diseases, including influenza and respiratory syncytial virus, which are always around in winter. Mild to moderate asthma is not a contra-indication to going back to school.
However, each case should be assessed and discussed with the individual’s doctor or paediatrician.
3. My child is healthy, but at home someone (grandparent/parent) is immunocompromised. Should we keep our child at home so that they can’t infect the rest of the family?
As stated above, the evidence shows that there is only a small risk of children spreading illness from school to home. However, it is important that the elderly/ill person at home is protected.
This means that if the child is going to school, in the home there needs to be physical distancing, strict hand hygiene and possibly mask-wearing if in close contact.
The elderly/sick person does need to remain as isolated as possible.
Each family needs to weigh up the risk to benefit ratio for themselves and make a decision based on what is correct for them.
Many schools will offer a blended learning environment or continued distance learning for vulnerable students. There are some families who need to take advantage of this. This should be discussed both with the school and with your doctor.
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