Covid-19: Practical ways to make it safer for children to attend school
As schools gear up to reopen, there is obvious anxiety among parents about the safety of their children and also what to expect in this covid-19 era. It is important to note that the virus is still with us and as we go into winter, the risk of transmission and infection will increase – thus, the lockdown was not a strategy to end Covid-19, but rather to prepare for it.
Covid-19 is a new disease but infectious diseases are not new to mankind. Infections happen when there is a sufficient amount of the infecting agent in the environment (mainly which people may touch and air) and sufficient exposure of time. Therefore, by reducing either one of these, one generally reducing the risk of infection. The third element of infection has to do with the strength to resist that infection (immunity) of the exposed person.
What has been reported in other parts of the world is the children have the lowest risk of getting sick even when infected and am even lower risk of dying from the disease. This is also true of other known infectious diseases such as measles, chickenpox and the related coronavirus disease called SARS. This should give comfort to parents in general as they contemplate whether to send children to school or not.
Further, while few can claim to be experts on this disease, we can use what we know about infectious disease to dispense good advice to parents, learners and teachers. Here we outline some good evidence-based advice which is worth noting.
Training and teaching
There is an assumption that everyone knows how to wash hands, wear masks and maintain physical distance. However, this is not the case. Proper handwashing is a technique, how to put on and use masks (especially when people are talking when they are also more likely to spit) needs to be taught and so that should be the first order of business when preparing your child for school.
This will need to be done every day until it is second nature to children and teachers (like brushing teeth or tying shoes).
Wearing masks is not the most comfortable thing for anyone, least of all children. We recommend face shields for children because they are easy to breathe through, can be easily and quickly sanitized and can be made into nice and interesting designs and colours for younger children.
The issue of social distancing will be a real issue because school, after all, exists to create socialization. For young children, the use of games, such as windmills or circles of distance, to inculcate social distancing is a good strategy.
The majority of children in South Africa commute to schools for historical reasons. Public transport presents the biggest risk of community-acquired transmission of any infectious disease. The risk increases in the winter months because windows are closed and the ventilation in trains, buses and taxis is poor. This, plus the crowding in these modes of transport increases the chances of droplet transmission and also contamination of surfaces, clothes and school bags (in the case of children).
Coronavirus has been shown to live on surfaces for long periods e.g. stainless steel 2- 3 days, cloth 2 days, plastic 3 days. Therefore, apart from wearing masks/ face shield in public transport, it is not advisable for people to wear gloves as these could lead to accumulation of the virus on hands.
What we suggest is for children to have outerwear of some sort e.g. overcoat or raincoat or gown. This they will remove and hang outside on arrival at school. Then at the end of the school day, they can wear it on their way home, making sure that they leave it outside upon arrival at home.
We note here the cultural practice among South Africans and Basotho of wearing blankets in the winter in public. While this is understandable since people start their commute in the chilly morning hour, this habit will lead to super spreading of the virus since these blankets are also used in the home.
Changing school hours
Related to the issue of the commute, it is advisable to change the school hours so that children commute after the rush hour, thus enabling some level of social distancing but also reducing community transmission between children and adults.
Having school hours fitted in between 9.00 / 9.30 and 14.30 at least for the winter months has several advantages. In addition to reducing congestion in public transport, it means that children are taught during the warmest part of the day. This may allow for classes to be held outside where there is better ventilation and sun.
Cross-demographic transmission was a huge driver of the pandemic in Italy, where children (who generally get milder symptoms of the disease) were found to be transmitting the virus to older and more vulnerable persons.
Alternating school days
Overcrowding in South African schools is as a result of successful enrolment of children into primary education. Naturally, the infrastructure and headcount of teachers did not follow the curve.
To reduce overcrowding, arranging classes so that they attend on alternative days from Monday to Saturday would be a useful strategy. It would avoid children having classes late into the day but also reduce exposure for both learners and teachers as well as high investment in PPE kits.
At least for the foreseeable future, schools with overcrowding could work on a 3-day week.
The sun is known to have a sanitizing effect on infectious agents in general. This is why many Europeans would be sent to Africa for convalescence from the consumption (which was caused mostly by TB infection).
Cecil John Rhodes was himself a subject of this treatment coming to sunny South Africa and ending up colonizing half the sub-region!
Therefore, having children taught in tents/gazebos and also for them to play outside during frequent and short breaks reduces viral load in the air. Gazebo and tents are also easily disinfected when opened to air overnight. Investing in wooden structures as being done is not advised since these structures are enclosed and hard to clean.
Track and tracing
The use of digital platforms and apps should be encouraged for use by parents and learners. It is surprising that even the more resourced schools do not seem to be using digital tools for logging in children and visitors to schools despite such tools being freely / cheaply available.
It was recently found in South Korea that non-digital record-keeping is not reliable when it comes to contact tracing. In addition, it is highly inefficient and also potentially exposes frontline staff to infection as they have to spend more time noting down details of each child and visitor.
There is an app developed by a South African non-profit Covid Connect App which is also in vernacular languages and available on both smartphones and feature phones.
What about vulnerable children?
While children are supposedly more resistant to coronavirus (because they have less of the receptors which the virus latches on to), there is a subset which may get very sick. This is where South Africa’s data on children may differ from that in other parts of the world.
In South Africa, the effects of co-morbidities such as HIV and AIDS, TB and respiratory infections are of obvious concern. Children with other conditions such as haemophilia and Down syndrome may also be vulnerable. In these cases, and as directed by the Department of Health, keeping such children at home is advisable.
However, this should not disadvantage them.
As happened in Brazil, multi-modal approaches to education should be utilized using a spectrum of delivery formats. These would be physical study packs, radio lessons and mobile phone interactions. It is important that all children feel engaged, valued and included.
A weekly phone call by a teacher to de-brief and hear out learners who are stuck at home will go a long way to reassuring that child that they are not alone.
At the end of the day, like many experts medical and educational experts have said, children are better off in school than at home. School is generally considered a safe haven in many communities and a useful form of daycare for working parents. If children cannot go to school, parents will find it hard to get back to work.
We believe that what has been discussed above when taken together with the various guidelines and regulations from the government will safeguard the health of children while allowing economic and social activity to re-start. But at the end of the day, it is parents who must make that decision guided by the available scientific advice.
* Prof D.R. Katerere and Dr Baatile Komane are academics and researchers at Tshwane University of Technology's Department of Pharmaceutical Science.
** The views expressed here are not necessarily those of IOL.