Published on 5 May 2020 in The Conversation.
In the UK, Education Secretary Gavin Williamson has said he wants nothing more than to see schools back but insists he cannot yet give a date since there were “no plans” to open schools over the summer while the UK awaits ‘scientific advice’[i]. In contrast, Prime Minister Mette Frederiksen launched the reopening of Danish schools last week while Angela Merkel in Germany and Emmanuel Macron in France said that their schools will reopen progressively after the 4 May and 11 May respectively. Different contexts, different decisions in Europe.
As the Director General of the WHO indicated on 12 March, on the subject of the management of the Covid-19 pandemic, it is a question of “finding a delicate balance between health protection, the prevention of economic and social risks and respect for human rights”[ii]. Professor Chris Whitty, the Chief Medical Officer for England, has also stressed the need to integrate a wide variety of parameters into policy decisions beyond the protection of the health care system and its capacity to care for the critically ill[iii]. Several times during daily briefings he has referred to the need to make a lockdown exit decision informed by the balance of the four different types of mortality that will occur: mortality directly related to Covid-19; indirect mortality related to the impact of the epidemic on the health care system; indirect mortality related to missed care, and ongoing mortality rooted in the health consequences of the economic and social crisis generated by containment.
Closing or opening schools during the pandemic are important political decisions, but they have to be based on the available evidence. Their re-opening will come, but many questions remain. We propose here to take stock of the data available today as to the timing and process of re-opening.
The impact of school closures on pupils
The available data show that school closures have an impact on all students and play a role in amplifying inequalities[iv]. The school is both a living environment for students and staff and an education setting[v]. Thus, in addition to the quantitative and qualitative impact on learning and the consequences for the mental health of pupils, closure deprives the most vulnerable pupils of school meals and support from education, health and social support staff, while confinement aggravates the economic problems of families which can lead to increases in episodes of domestic violence, child abuse and neglect[vi]. Cutting-edge neuroscience research shows that the brains of young people need to be wired for social connection during adolescence in order to maintain health and wellbeing[vii]. Deprivation of social stimuli during this critical period of development can have long-term consequences for future adult lives.
The impact of school closures on the epidemic
Observational and modelling data are available on outbreaks of viruses for both influenza- and coronavirus-related diseases (SARS, MERS and Covid-19). However, since it is difficult to isolate school closures from other measures instigated in pandemics, and the virus responsible for Covid-19 is not sufficiently well understood, it is not possible to draw definitive conclusions. The literature review published in the Lancet Child and Adolescent Health by Russell Viner and his team shows that, in previous coronavirus epidemics, transmission in schools was very low or absent[viii]. Recent modelling studies for the Covid-19 epidemic predict that school closures would prevent only 2-4% of deaths, far less than other social distancing interventions.
Although the available data remain patchy, it is clear that there are no strong arguments for maintaining school closures. It appears that reopening schools might be implementable if combined with barrier use, social distancing measures and a robust programme of testing, contract tracing and isolation.
However, this scientific knowledge alone is not sufficient to guide policies and practices; it is necessary to link it with other sources of knowledge, particularly from the experience of other countries and the knowledge of professionals in the field. Convergence of data is needed to identify what is desirable and achievable.
Feedback from countries whose schools are not closed
A second source of vital information is feedback from countries that have not closed schools or who re-opened them some time ago. We have chosen to focus on the situation in Taiwan, a country which has been widely recognised for its successful management of the crisis[ix]. Indeed, the number of cases has remained very limited (395 cases and 6 deaths as of 18/4/20), despite its proximity to mainland China. This is largely due to the preparation of institutions, extensive intersectoral work at all levels and an early and comprehensive reaction. Vice-President and leading epidemiologist Chen Chien-jen cited their relevant learning from the SARS crisis in 2003 as “prudent action, rapid response and early deployment”[x]. Testing of close contacts of those infected, and their subsequent 14-day home quarantine, was a primary strategy for containment.
With regard to school closures, the following rules were enacted at the national level[xi]:
- If a teacher or student is affected, he or she is not allowed to attend school for 14 days.
- If two or more teachers or pupils are confirmed to have contracted the disease, the entire school is closed.
- If one third of the schools in a district or city are closed due to infection, all schools will be closed.
At school level, the following measures have been implemented: in classrooms and canteens, pupils are separated from each other by plastic partitions between desks, systematic temperature checks are carried out and the wearing of masks is compulsory.
A study carried out among secondary school pupils showed an excellent integration of barrier measures and the fact that a majority of pupils (70%) considered that these measures have not affected their learning[xii].
Even if such comparisons must be made with caution, due to differences in cultural and social contexts, in the experience of epidemic management by the authorities or in the familiarity of populations with barrier and social distancing measures, these learning points can still be helpful for the UK.
Benchmarks for the reopening of schools
In the period ahead, the challenge is to design an education system that allows both effective learning and the protection of the health of students and the professionals who supervise them. This cannot mean returning to organizational arrangements equivalent to those in place prior to the crisis. On the basis of the available data, it is possible to identify four benchmarks likely to guide both political decision-making and the action of parents, pupils and professionals.
1. A differentiated and progressive system
As the level of epidemic risk, the social and health vulnerability of pupils and the characteristics of the premises available differ across regions, and even from one school to another, it is not possible to carry out the re-opening process in the same way everywhere. The wider regional/local context in terms of testing, tracing and isolation strategies must be considered. It thus appears that an approach combining a national decision-making support framework and local steering mechanisms – bringing together elected representatives, education stakeholders (management, administrative, teaching, health and social, service and technical staff), safety, school transport and public health, families and pupils – is a practical way forward.
The main challenge will be to create the conditions for concrete and effective intersectoral work at the local level. It is not a question of ensuring that the rules are respected and that the professionals comply with them, but rather of relying on their knowledge – forged in contact with the pupils – in drawing up a strategy that takes into account their experience, their proposals, and their own concerns[xiii]. To do this, in addition to making resources available to organize school life, significant time must be devoted to consultation. In addition, it is necessary for professionals to be able to benefit from training, intersectoral support (health and education) and high-quality resources. Collections of tools have been developed at the international level[xiv]. Public health risk assessment of services outside direct school control, such as public transport used by children and parents, must be part of the overall plan.
Finally, because of the lower learning autonomy of young children, and the early onset of social and educational inequalities, priority should be given to primary school re-opening before secondary schools. This is what Denmark has done, having first re-opened its nursery and primary schools, and it is also the recommendation of the German Academy of Sciences.
2. An organization to protect students and staff
Research data confirm the relevance of social distancing combined with frequent hand washing or the use of a hydro-alcoholic sanitiser gel. Wearing a mask – or face covering – remains a controversial issue, although a recent review by Trisha Greenhalgh and colleagues recommends widespread adoption of this practice in line with the “precautionary principle” when scientific data remain elusive[xv]. On the one hand, it appears that the mask, even if it limits splashes, does not offer sufficient physical protection because the virus is spread by droplets and contact with contaminated surfaces. On the other hand, wearing a mask is a very visual reminder of the dangers of the virus and could act as a “behavioural boost” to support people’s commitment.
A robust re-opening plan will have to be drawn up for each school and establishment: hygiene measures should detail the cleaning of the premises, access to handwashing facilities, and the provision of masks. The number of pupils present simultaneously in different spaces can be reduced by specifying methods of circulation in the establishment, the reorganization of classrooms to increase the space between pupils, and staggering breaks and lunch times. Reducing the movement of pupils in the secondary school can also be achieved by asking the teachers to move from class to class and not the pupils, reducing the length of the school week, and separating classes into two groups that present alternately in the schools. Even the functioning of school transport will need to be studied and reorganised.
3. A hybrid pedagogical approach
The period that has just elapsed has led to the exploration of new pedagogical modalities. In countries where it has been studied, a large majority of teachers and parents have adapted well to distance teaching and learning, but a minority of them face significant difficulties[xvi]. Specific arrangements will need to be stabilised to ensure that all students have the means to work.
Given that it will most likely be necessary to reorganize school and home attendance times, there is already a need to prepare for hybrid teaching arrangements and greater individualization of pupil pathways in order to help reduce inequalities.
The launch of a new UK scheme to supply laptops and routers to disadvantaged pupils during lockdown only serves to highlight the educational resources (equipment, quiet space, broadband connectivity) that prove challenging to guarantee in every family home[xvii].
4. Renewing our vision of the epidemic
Research shows that regardless of school opening and closing instructions, absenteeism of both students and professionals can be very high during epidemics due to both illness and voluntary withdrawal. With regard to distancing measures, it appears that while activities and contacts decrease, they do not cease. This is particularly true for children whose parents did not agree with school closures[xviii]. It is necessary to empower everyone to understand why schools are being closed or re-opened when the ‘war’ against the virus is not won. After an acute phase in which the priority is to protect the capacity of hospital emergency and resuscitation services, it may be necessary to enable everyone to have a more operational vision of the epidemic for their own ongoing daily lives. Two variations on this theme might be suggested:
Firstly, it is not reasonable to rely on a magical vision of resolving the crisis with a miracle drug or a vaccine. There is no guarantee that such treatments will be available in the short term. It will therefore be necessary to learn to live with the virus as is the case with other coronaviruses, HIV and Ebola. The epidemics of SARS, MERS, HIV/AIDS and Ebola disease have not been brought under control by medical treatments but mainly by screening and population-based approaches to protection. They call for the development of citizen skills and personal responsibility. Reports that the reproduction number for COVID-19 is now below 1 in the UK, meaning that the epidemic should start to decline, provide motivation to maintain distancing measures. Monitoring this is part of France and Germany’s strategies for its re-opening.
Secondly, in order to understand how to live with the virus, it seems important to help everyone to understand that we are in an adaptive process linked to the dispersion of a virus within human populations. At the end of this process, a new balance will be established without the virus disappearing, but its transmission will be limited. If a vaccine can be developed, it will assist with the immunization of the population while minimizing the risks to the most vulnerable.
When classes reopen, it will probably be necessary to put the pandemic at a distance and focus on other subjects. However, because of the anxiety-provoking context that we are now familiar with, it will also be essential for pupils to be able to reinforce their knowledge of microorganisms (and not only viruses), to have a more ecological vision of the relationship between microbes and everyday health, to work on media literacy and critical thinking, and to see their well-being taken into account. Existing curriculum materials such as the EU ‘e-bug’ series may be helpful in this regard[xix].
Drawing on all the available evidence, including both research evidence and experiential evidence from countries that have successfully contained the epidemic without closing all schools, can not only help to implement the solutions best suited to our context, but can also empower the entire population to understand and act effectively within the confines of the present situation.
After the initial phase of ‘fighting’ the epidemic, we must learn to live with the virus. There is no unequivocal scientific basis telling us how do so. The challenge is to know how to act under conditions of uncertainty on the basis of benchmarks that are always limited. In order to achieve this, three types of knowledge must be combined: those resulting from scientific observation or modelling studies; those resulting from the experience of other countries, and those of professionals in the field in direct contact with pupils. Thus, over and above technical issues, it will be necessary to review ways of working, strengthen intersectorality, articulate knowledge from various sources, develop decision-making and action capacities at the regional and local level, etc.
Finally, the implementation of systematic monitoring and dedicated research work is needed to strengthen the available data. The Covid-19 pandemic is an opportunity to deepen knowledge, produce benchmarks for action and prepare the response to future epidemics.
Didier Jourdan, Professor, Holder of the UNESCO Chair and WHO Collaborating Centre in Global Health & Education, Université Clermont Auvergne
Nicola Gray, Vice President – Europe, International Association for Adolescent Health, Affiliated Researcher, UNESCO Chair and WHO Collaborating Centre in Global Health & Education, Université Clermont Auvergne
Michael Marmot, Professor, Director, UCL Institute of Health Equity, UCL Dept of Epidemiology and Public Health
Thanks to Min Chien Tsai from Fu jen University, Taipei and Valérie Ivassenko from the UNESCO Chair and WHO Collaborating Centre in Global Health & Education, Clermont Auvergne, France.