Article by Prof. Peter Collignon
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 extremely be disadvantaged. Minimal or no mixing with their friends and other children for over six months will also have harmful 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 Gauteng, there’s been no recorded COVID-19 case where a learner or teacher acquires the virus at school. 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 on-going spread within the community.
What we are seeing currently with our rapid increase in numbers, is not an uncontrolled epidemic in South Africa.
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 going back home. Since its already 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 learner 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.
Professor Peter Collignon is an infectious diseases physician and microbiologist at Canberra Hospital and professor of medical school at Australian National University