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With discussions in high transmission settings about what to do with schools, I go through Victoria’s experience. We eliminated the virus but schools were closed during lockdown except for essential workers (high risk in our setting). 1/
2/ Parents worried about their child’s mental health. Serious mental health issues increased. Paediatricians were worried about the impact of toxic stress & school closures on children’s developing brains, child abuse, & long term impact. 3/ https://www.thecut.com/2020/11/covid-19-pandemic-kids-mental-health.html
3/ It was urgent to get the kids back to school safely (see Adolescent, Child Protection, Mental Health section). We analysed the school outbreak data, reviewed the science on children & schools in transmission, & mitigation measures needed. 4/ https://medicine.unimelb.edu.au/news-and-events/covid-19_kids_research_evidence_update
4/ Children are at low risk of severe disease; are susceptible to infection & transmit when symptomatic. Children <10-12 less likely to transmit than adults. Older adolescents are similar to adults. Role of asymptomatic young kids in less clear but most likely transmit less. 5/
5/ School outbreaks occur. But evidence suggests that transmission within schools is not of the same efficiency as adults, especially in children <10 years, & with mitigation. Teachers in UK not at higher risk than other jobs 6/
6/ Schools & children contribute to community transmission, but implicating schools as a major reason doesn’t take into account the effects of other restrictions on adults (parents) work & social activities, which usually occurs simultaneously when children return to school 7/
7/ Recent Public Health England report found schools were not a common location of contacts for any person testing positive: 3.5% from secondary, 1.8% from primary & 1.1% from preschool. 8/ https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/934812/Weekly_COVID-19_and_Influenza_Surveillance_Graphs_W46.pdf
8/ Living with a child in UK does not increase the risk of a severe outcome in adults & the elderly living in the same household (study included >9m adults ≤65y & >2.5m adults >65y) 9/ https://www.medrxiv.org/content/10.1101/2020.11.01.20222315v1
9/ If public health responses are strong following detection of a case in a school, then onward transmission is low. In NSW it was 1%. In Victoria 67% of infections in schools were single cases & >90% were <10 cases 10/ https://www.ncirs.org.au/covid-19-in-schools
11/ We found in Victoria, kids <12 seemed to transmit the virus < adolescents & adults. If 1st case was a young child, outbreaks were uncommon. Rapid responses to school cases for cleaning & quarantining contacts occurred. 12/
https://www.mcri.edu.au/news/covid-19-victorian-schools-and-childcare-mainly-driven-community-transmission-analysis-finds%C2%A0
https://www.mcri.edu.au/news/covid-19-victorian-schools-and-childcare-mainly-driven-community-transmission-analysis-finds%C2%A0
12/ School transmission reflected community transmission. We think it community cases spilling into schools as there were no areas with a large numbers of cases linked to schools & low numbers of community cases. 13/
13/ Many cases occurred in households & don’t seem to spread in schools. Serious disease was rare in kids & staff. 14/
14/ For psychosocial reasons, schools should be the last to close & the first to open. Best policy is viral suppression in the broader community. Adults need to wear masks + social distance + stay home + get tested + quarantine if sick etc. 15/ https://schools.forhealth.org/
15/ School mitigation basics: improved personal hygiene, enhanced environmental cleaning, improved ventilation, physical distancing for staff, staying home if sick etc. Rapid public health responses to a school case are vital to prevent onward transmission. 16/
16/ Mitigate should be proportionate to level of local transmission. For moderate & high transmission: For secondary: masks for staff + students; For high transmission: blended learning (on/offsite). 17/
17/ Dialling up & down measures prevents community fatigue, is more feasible, & allows schools to stay open for as long as possible during the peak of transmission to avert a lost generation, prevent further inequities and the unintended harms from the pandemic response 18/
18/The ultimate solution, however, maybe to vaccinate kids if there is a safe & effective vaccine that prevents transmission. 19/
19/ Victorian school report 20/
https://theconversation.com/behind-victorias-decision-to-open-primary-schools-to-all-students-report-shows-covid-transmission-is-rare-147006
https://theconversation.com/behind-victorias-decision-to-open-primary-schools-to-all-students-report-shows-covid-transmission-is-rare-147006
20/ There will be ongoing debate about the role of children & schools & more research is needed. But Ireland is a good example of what happens in practice- in lockdown but schools remained open + no masks primary. Cases are declining fast. 21/
21/ Ireland took advice from here took advice from Vic’s Chief Health Officer who in retrospect would have kept schools open (schools discussed at 30:15 and 1:16:00). 22/
22/ Iceland kept schools open all year. France’s cases are declining fast while keeping schools open & students protest about lack of mitigation. More data are required to develop the most effective school policy to minimise closures & minimise psychological & educational harm.
23/ How to improve ventilation 24/ https://www.sciencedirect.com/science/article/pii/S0160412020317876
25/ @unicef on how to prevent a child’s right’s crisis https://www.unicef.org/coronavirus/six-point-plan-protect-children?utm_campaign=six-point-plan&utm_source=twitter&utm_medium=organic
