Pediatricians from the US, United Kingdom, among others, strongly recommend the earliest re-opening of schools

Many governments in Europe and Asia have put reopening of their schools and face-to-face classes, especially that of young children, as a priority as Covid-19 lockdown restrictions are eased. These governments, with the help of health experts and educators, put children at the forefront of their struggles to overcome the pandemic, by getting their lives back to normal as soon as possible and by providing their parents a respite to the months-long responsibility of caring for and teaching their children alone.

US pediatricians, through the Journal of American Medical Associated, a publication of the American Medical Association, recently expressed disappointment that US states which provisionally planned for opening workplaces did not give consideration to opening schools. It noted that many US states have cancelled the previous school year when the pandemic first bit, and are now prolonging the school interruption by cancelling or delaying the next academic year.

The publication stated that “the risks posed by delaying school openings are real and sizeable, particularly for students from low-income families.” Pediatrics, a journal of US pediatricians, noted that there is “nearly universal agreement that widespread, long-lasting school closures harm children.” It stated that “not only do children fall behind in learning, but isolation harms their mental health and leaves some vulnerable to abuse and neglect.” In a pandemic, where adult work- and money-related stresses escalate, this run to a hundredfold.

Unsurprisingly, late June this year, no less than the 67,000-strong American Academy of Pediatrics (AAP) went against the advice of the US Centers for Disease Control and Prevention which stated that the “remote learning” is the “safest option.” The pediatric organization “strongly recommended” that students be “physically present in schools,” noting that the risks and harm of them not doing so outweigh the risks of contracting the virus. The AAP has come up with eight principles in considering school re-entry policies in its paper entitled “COVID-19 Planning Considerations: Guidance for School Re-entry,” last updated on June 25. It emphasized that all policy considerations “should start with the goal of having students physically present in school” and not on stop-gap measures.

The organization asserts that schools do not just provide academic learning to children and adolescents. These also serve as a venue for students to develop theirsocial and emotional skills, and to exercise and get access to mental health support, among many others that cannot be provided by online learning. Nevertheless, its foremost principle is for schools to be flexible and nimble, ready to adapt and revise strategies should the level of transmission change. If infections surge, going virtual could be a temporary alternative. Schools, alongside the community, will just have to work harder to make face-to-face classes possible again.

The UK’s 2,500-strong Royal College of Paediatrics and Child Health made the same appeal to the UK government, stating that keeping schools shut “risks scarring the life chances of a generation of young people.” It noted that the brunt of the impact of the pandemic “is and will continue to be borne by children and families who have the fewest resources and need the most support.”

Most pediatricians do not discount that that outbreaks in schools can happen, and are even inevitable, but the benefits of opening them outweigh the risks. Even so, they reiterated that: “Every child deserves to have an uninterrupted education.”

Do not blame the children

Pediatricians who advocate going back to face-to-face classes base their recommendations on available data and studies on child Covid-19 transmission and infections. There has been an explosion of researches, with some published and peer-reviewed, on the “surprising aspect of the pandemic” wherein children appear to be infected “far less frequently than adults and, when infected, typically have mild symptoms.” On the other hand, there arealso studies which cite that risks of infection could be higher for older children, especially in states where transmission is generally high. Particularly, concerns have been raised as some infected children have developed a potentially inflammatory syndrome, but these have been uncommon and generally treatable.

Children are also “less likely to spread the infection,” particularly those under 12. In fact, data indicate that most infected children contract the virus from adults, and not the other way around. This lends to the preliminary finding that children are not “silent superspreaders” who “put adults at risk.” In a review of 700 publications, children are rarely the first case in a cluster of infections in a household. In the US, a vast majority of pediatric Covid-19 cases that occur inside familial clusters originate from adults.

In another study by the Public Health Agency of Sweden, it was determined that overall, child infections in Finland and Sweden appear similar, even though Finland closed schools and Sweden did not. Both had more or less same rate in child infections, and both had zero pediatric Covid-19 deaths among the 19-below set. A study published in The Lancet, an independent globally-respected medical journal, even suggested in May that the “key to understanding Covid-19 susceptibility” may lie in the immunity system of children, seeing as they are least vulnerable to being severely infected.

Vigilance is needed

Daycare and primary schools in some countries in Europe, as well as in Asia, have made strides in opening schools safely by following health protocols and keeping a close watch on child infections. Most are now pushing for full-time, full-capacity, in-person classes, especially considering there have been no report of school-based Covid-19 outbreaks. Some countries have even started abandoning social distancing protocols among children under 12 after observing zero or rare incidents of child-to-child transmissions. In Belgium, the Minister of Youth pushed for the opening of schools, parks, playgrounds and camps for children last May and on keeping them open “even with a second wave of infections.”

Still, vigilance is needed. There is continuing concerns about face-to-face classes for teens and college-age students, as they are more susceptible than elementary pupils, although still less susceptible compared to adults. In countries, or cities where infections remain high, pediatricians recommend more elaborate, and unavoidably more expensive, measures to avoid closing down entire high schools, colleges and universities every time a student tests positive. The AAP drafted several guidelines on how students could avoid overcrowding in common areas such as hallways and buses, among other recommendations. It also recommended “remote meetings” for teachers and staff to avoid adult-to-adult transmission. Infected children should be kept at home and afforded the highest possible care.

Furthermore, pediatricians who advocate face-to-face classes agree that there should be school-based Covid-19 symptom screening, testing, contact tracing, and isolation to mitigate the risks of opening schools amid the pandemic. Opening without a plan to test is “irresponsible and a gamble” not only with the children’s health, but those of teachers, staff and parents as well. Same goes for blanket calls to reopen schools without the ensuring the most basic of protective measures, such as the one being pushed by the Trump administration in the US. Wearing of masks, especially among adults and older children, remain central to most reopen strategies.

American pediatricians recommend that, at the very least, an expert task force focusing “exclusively on school closure” should be convened to help states (and governments) reopen schools safely and as soon as possible. This task force, to be made up of epidemiologists, infectious disease experts, educational scientists and child psychologists, among others, should review evidence on local and state-wide transmissions among children and their families, and review the feasibility and psychological impact of distance learning. Decisions and recommendations should be made using available data, however imperfect or incomplete, and should be based on science and not politics.

Much needs to be done

In more backward countries like the Philippines, much needs to be done to provide critical facilities required for the safe reopening of schools. A holistic assessment of every school must be carried out to identify weaknesses and priority needs. Decades of neglect of the public school system has led to an acute shortage of school buildings, classrooms and facilities. Existing infrastructures are dilapidated. There are no dormitories and most schools have no safe and ubiquitous water systems, comfort rooms and other sanitary facilities such as hand washing equipment, which are critical in managing the spread of the virus. Schools are perennially understaffed and teachers, overburdened and underpaid. Most do not have medical personnel. Additionally, there have been no real effort so far to gauge the effects of school closures and other harsh restrictions on Filipino children and youth, especially those who experience extreme poverty, and those vulnerable to abuse and violence.

In the Philippines, the Department of Education and Commission on Higher Education’s badly-designed and anti-poor “online” or “blended” learning has drawn flak from various sectors, including teachers and parents. Most of them do not have the equipment, gadgets and funds required in conducting online classes. This is a heavy and almost impossible burden especially to parents whose jobs and livelihoods have been decimated by the pandemic. Even so, the Philippine government has refused to even consider opening schools in low-risk areas, with Pres. Rodrigo Duterte ordering all face-to-face classes to be postponed indefinitely or “until a vaccine is available.” Accordingly, it has refused to consider and fund the most minimal of safety requirements to open schools safely, and instead opted for the most expensive, yet most inaccessible and ineffective, online and modular learning.

Pediatricians from the US, United Kingdom, among others, strongly recommend the earliest re-opening of schools