Covid-19 Pandemic and School reopening - Are we ready?

Dr Nagendra Chaudhary
Covid-19 pandemic, in addition toadverse health impacts, including over a half-million deaths, has affected education, environment and social life.There are more than 35,000 elementary and secondary schools in Nepal. All these schools have been closed in Nepal for overthree months. The main decision of closing the school was considered by the government to maintain social distancing and isolation so that the chain of transmission couldbe broken, if any. The closure of schools has helped in reducing the magnitude of the pandemic in Nepal with fewer cases in children and reduced burden to the health care system. Closure of schools has also helped in lowering and flattening the pandemic peak.Now, after a few months of complete lockdown, limited movement of people has been allowed along with many sectors that have gradually started opening up.The education sector, particularly schools, continue to remain closed. “When to reopen the schools?” has now becomea big question and a challengefor school administrators, government and parents. Premature decisions and early lifting to reconsider the opening of schools may lead to a rise in secondary peak.
Children forced to stay at home has decreased the transmission of SARS-CoV-2 in children in comparison to adults. Also, various studies have confirmed the reduced infection rate in children compared to adults. But, isolating these children from their “social world” should also not be taken too lightly as it might have a long-term negative impact on their psychosocial and mental health. Various recent studies are supporting that social distancing and isolation due to school closure may lead to the emergence of anxiety, depression and post-traumatic stress disorders in children during and after the Covid-19 pandemic. In low- and middle-income countries,various schools provide mid-day meals, a major source of nutrition for the poor kids, the closure of the school is likely tohamper the nutrition of those children. 

Are children going to increase in the transmissionof the outbreak in case the schools are reopened?
Worldwide,a tiny percentage of children are reported to be infected with Covid-19 (i.e., less than 5%). Although children are as likely as adults to be infected by the virus, causing Covid-19 disease, the majority of them are either asymptomatic or mildly infected. School reopening might have a risk of transmission of the virus by the children, but the role of children in the transmission of Covid-19 is too preliminary and inconclusive in the present context. Studies to date have suggested that, in an average 7% of close contacts become infected. Among those infected,particularly in the overall population, around 80% of these contacts show symptoms, and the remaining 20% are symptom-free. Hence, 20 %of children will be the major challenge for the transmission of the virus in case the schools are reopened. This also emphasizes the need for increased testing of Covid-19 in children. A positivity rate of less than 5% for two weeks is considered as the epidemic is under control. But, testing all the children in developing nations like Nepal is not feasible nor practical or possible.Although there is a reporteddecline in Covid-19 cases at the moment, the virus is still in circulation. This virus is likely to remain for a long while in Nepal and abroad, and until then, we need to enhance the testing capacity, trace those who were in contact with positive cases and isolate them.

Major problems that can arise due to forced school reopening
Nothing can replace the classical classroom teaching. Although the government and school administration can rethink reopening the school, the smooth running of the schools will depend upon the attendance of students and staff. Many staffs can deny to re-join the school in the present context. If there isa suboptimal number of teaching staff in the school, the supervision of children will be compromised, which may lead to an increase in the rate of infection. On the other hand, the parents` perspectives are also crucial to understand regarding the reopening of schools. In the current circumstances, the majority of parents are more likely to deny to send their kids to the school as they are not mentally prepared. 

Important points to be taken into consideration before reopening the schools
CDC and UNESCO have come up with guidelines regarding the query on reopening the schools. The following questions need to be answered before considering opening the schools.
    Capacity and facilities in the schools- Do the schools have adequate capacity to maintain social distancing? The schools will need to have large enough classrooms for children to follow the social distancing rules. What are the drinking water facilities, hygiene facilities and sanitisation practices?
    How will the children be travelling to schools? How the transport buses/vans will follow the social distancing practices?
    How is the school going to screen children and staff for symptoms and exposures?
    Is the school capable of protecting children and its staff from severe illnesses? 
WHO and UNICEF (March 2020) have issued interim guidelines regarding the prevention of Covid-19 at schools. WHO (in May 2020) released School related public health measures that guide us to consider specific points before reopening the schools.

Points to be considered before reopening the schools are
    Covid-19 secure measures should be followed to reduce the risk of transmission.
    Schools should promote social distancing.
    Sick students and staff should not come to school.
    Keep children in small groups; so that in case someone is infected, only that group could be self-isolated.
    Encourage older children to keep their distance from each other and staff where possible. 
    Schools should enforce regular hand washing with safe water and soap, alcohol rub/hand sanitizer or chlorine solution and, at a minimum, daily disinfection and routinecleaning of school surfaces.
    Schools should provide water, sanitation and waste management facilities and follow environmental cleaning and decontamination procedures.
    Understanding the severity of disease in children and the probability of transmission in children (as data in children is not sufficient at the moment to explain it).
The responsibilities on the hand of schools and teachers have also increased due to the Covid-19 pandemic. They are- 
    Children have lost learning at home. So, they need to help those children to catch up on the lost learning by modifying the curriculum and teaching methods. This revised approach will help to fulfil the “gap in knowledge”. 
    Teachers need to maintain distance from each other and older students where possible
    The school administration needs to increase the frequency of cleaning and reduce the use of frequently shared items.

In the end, let us rethink again “are we ready to reopen the schools?

-(Dr Chaudhary is an Associate Pofessor in paediatrics at Universal College of Medical Sciences, Siddhartha-Nagar) 

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