‘Closing schools could lead to more deaths’
Closing schools at this point in time will likely do more harm than good and potentially lead to more deaths and use of hospital beds from Covid-19 infections.
There is a lot we still don’t know about Covid-19. What we do know is that children appear to very rarely have serious disease and complications, compared to those in the older age groups – especially their grandparents.
The data from a range of countries shows that children rarely, and in many countries never, have died from this infection. Children appear to get infected at a much lower rate than those who are older, although confirmation of that will need to await the rollout of large-scale antibody testing, which tells you that you have had an infection in the past.
Although there is still some uncertainty of infection rates in children, there is no evidence that children are important in transmitting the disease.
Children can get infected and children with infections – usually acquired from older family members – have been at school, but there have been no documented outbreaks in those schools.
There are many potential detrimental effects if we close schools now. Firstly, on the children themselves. Many will likely miss out on over six months of teaching. While online learning might be available it is unlikely to be as effective as face-to-face teaching and those with less resources will disproportionately be disadvantaged. Minimal or no mixing with their friends and other children for over six months will also have deleterious effects.
School closures by themselves are our least effective preventative strategy. The most important interventions are quarantining those with infections and those having a much higher risk and those over 70 years old having maximal social distancing.
In Australia, as of 25 March, we still have very low community transmission of this virus. The cases we are seeing are overwhelmingly in those who are returned travellers and in their contacts. Hopefully with our quarantining of cases and high-risk individuals – people who have been close contact as well as returned travellers – we will be able to limit any ongoing spread within the community.
What we are seeing currently with our rapid increase in numbers, is not an uncontrolled epidemic in Australia.
If it is quarantined from community spread here, we should see a fall in numbers in a month or so, two weeks after the last of our last returned travellers trickle back home. However, we will then be close to entering winter here, which is the peak time for spreading of nearly all respiratory tract viruses, including the likelihood of this one. So, whatever we put in place now will likely need to stay until at least September.
Closing schools will not likely decrease the spread by much in our community but will be associated with lots of potentially long-term and detrimental outcomes on the education of our children. It will also impact the ability of society to function and deliver essential services. It may even increase deaths from Covid-19 based on some modelling.
Most models done so far are with assumptions that the virus spreads in similar ways to influenza. This doesn’t appear true for Covid-19.
It appears to cause less infections in children than occurs with influenza. While we don’t know the exact infection rates in children, symptomatic infections appear to be much lower than what would be expected to occur with influenza in children.
An Imperial College model assumes that if schools are closed, household contact rates for student families will increase by 50% during closure. Contacts in the community increase by 25% during closure.
This assumed increased contact in families and in the community are I believe reasonable assumptions but has major implications for those in the community over 70 years old, the most at risk for death from Covid-19. This increased interaction may be why there are worrying findings of a potential increase in deaths in the first three months after school closures, instead of seeing a decrease.
If schools are closed, there will be a need for these children to be cared for during the day, as they will need to stay at home. This will impact the delivery of many essential services including nursing staff, cleaners, suppliers of foods etc. If they are then looked after by grandparents, this may well increase the risk of infection to those most vulnerable for bad outcomes.
‘The message is too confusing with schools open’
I was originally not in favour of school closures because I was expecting authorities to close borders, enforce self-isolation and have people be compliant to keep the infection away from the general public.
The interventions that were happening were too slow and the messaging has been too confusing. People need a clear message about staying home and part of that clear messaging is closing schools.
Kids are unusual in that they represent across the world, less than 2% of all cases. Scientists are starting to look at whether or not it’s due to a receptor site that the virus likes and that perhaps the children aren’t expressing it. Or that their immune system somehow protects their lungs from becoming overly inflamed.
Regardless of how it happens, I was working on the idea that children were less likely to become cases, so we should keep the schools open and the staff could be tested more often to keep them feeling calm.
But I don’t live very far from a school and I have watched parents dropping off and picking up children and not understanding social distancing. They’re dropping their children off and socialising.
So keeping the kids at home, out of school, may well keep the parents from socialising and at home as well, but that’s going to be economically difficult.
We’re in this situation now because of a slow border control.
It is confusing messaging for people to be told that they have to stay at home while they are also being told that their children can go to school. It’s very difficult.
In Australia, most of us are used to living in very, very, very safe communities. So social messaging is tricky, but people have been told such conflicting things.
On the one hand, they were told they could still go to football. And then very rapidly, they decided that social gatherings were not acceptable. And then slowly they were told maybe football.
It’s not logical, and our community are logical. Australians are a community of well educated and thoughtful people; they can get it if you explain it to them, and give them the full rationale for why you’re doing things and why you’re not doing things.
But instead they are being given some confusing messaging, which makes them think “well, if I can send my kids to school, I can hang around and chat to the mums, I can sit in the coffee shops”.
Children aren’t really at risk of spreading Covid-19 through the schools, the data at the moment has shown overseas that children were more likely to have acquired their infection from a family member.
If schools are going to stay open it needs to be with other messaging for the parents to go to work or go home, don’t hang around, keep your distance. Stagger the starting time at school, try and take them outside and have a lower expectation of perfect and a lower expectation of what you can achieve during class time.
Don’t confuse people, don’t have a message that could be conflicting. Just be very clear that they need to stay home.
They should also provide testing for staff members who may be anxious. I understand their anxiety and we need to not undervalue that.
Given that we haven’t done any of these things, it’s a clearer message to send most of the children home.
My opinions are based on how one deals with classic outbreak interventions and not influenced by economics. They are purely from an outbreak investigation approach, which is much easier to apply.
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Marylouise McLaws, epidemiologist and member of the World Health Organisation (WHO) Health Emergencies Program Experts Advisory Panel for Infection Prevention and Control Preparedness, Readiness and Response to Covid-19
