23 May 2020
The science of re-opening of our schools
Dr Musa Mohd Nordin
Dr Thiyagar Nadarajaw
Malaysian Paediatric Association
The science (or lack of) of juggling with the issue of re-opening schools has been daunting and much polarized.
Is it safe?
And if we choose to re-open our schools, what precautions should be in place to protect them whilst in schools?
Iceland is probably the only country that has done lots of testing and has diagnosed lots of infections. In a population-based study in which 9,199 were tested, of the 564 children less than10 years old, 38 (6.7%) tested positive. This contrasts with 1183/8635 (13.7%) adolescents and adults tested positive, suggesting a lower incidence in children.
Among 392 household contacts of 105 index COVID-19 cases studied in China, the overall household attack rate was 16%. The secondary attack rate was highest in spouses (28%), all adults (17%) and was lower in the under 18 years age group (4%).
From the available clinical series and national datasets, children and young people constitute less than 7% of COVID-19 positive cases. They make up even smaller proportions of severe cases and deaths.
Three (9.7%) out of 31 household transmission clusters in China, Singapore, South Korea, Japan, and Iran were identified as having a paediatric index case. This is unlike other infections, like influenza virus, where 54% (30/56) of transmission clusters identified children as the index case. Current data seems to suggest that children do not play a major role household transmission of SARS-CoV-2.
In a French chalet cluster, 11/15 contacts tested positive with a 75% attack rate. One case occurred in a child who was also co-infected with other respiratory viruses. He attended 3 schools and ski classes, yet did not transmit the disease to his classmates. This seems to suggest different transmission dynamics and that children might not be an important source of transmission of this novel virus.
A study conducted in 15 schools in Australia found a transmission rate of 0.23% for the coronavirus-19 between the infected children and their close contacts.
Studies also showed that children and young people under 20 years of age had lower susceptibility to infection, with 56% lower odds of catching SARS-CoV-2 from an infected person, compared with adults.
Clearly if children are less susceptible, they have less chance of transmission at a population level, and this is supported by presently available data.
Although limited, these studies so far indicate that susceptibility to infection increases with age (highest more than 60 years old) and growing evidence suggests children are less susceptible, are infrequently responsible for household transmission and are not the main drivers of this epidemic.
This informs us that the vast majority of children can attend schools quite safely.
We all agree that our children needs to be schooled and nurtured. The school setting is still the tested and proven teaching ground. Home based learning through new technology during the lockdown is still in its infancy and the impoverished B40 are deprived due to lack of access to cost prohibitive facilities.
The vast majority, especially primary schoolers, are still missing the traditional face to face classroom teaching environment.
Balancing the odds we know that it is safe for children to return to school but we need to put in place measures to reduce transmission.
Attention to personal hygiene, safe physical distancing, use of mask would help to mitigate this. This needs to be supplemented with careful infection control activities in schools and rapid response to potential case with prompt testing and a robust contact tracing system. This has been addressed in much depth elsewhere.
The adverse consequences of continued and further school closure is undoubtedly detrimental to the cognitive potential of our children let alone their physical, social and emotional health.
No one said it will be easy but with good partnership between ministry, schools, teachers, parents and students we can pull this through together