A drawing by 10-year-old private school pupil Evan Hum on the importance of vaccination in protecting schoolchildren. — Dr MILTON LUM
Schools not only support the educational development of children, but can also play a vital role in addressing social inequity.
The benefits of schooling include academic instruction, development of social and emotional skills, provision of health services and opportunities for physical activity.
Covid-19 initially did not affect children as frequently as adults.
However, with broad community spread of the infection, the number of children getting sick and being hospitalised has increased globally, including in Malaysia.
For example, record numbers of children are being hospitalised in the United States.
It is unclear whether this is due to the SARS-CoV-2 Delta variant’s increased spread or whether it also causes more severe disease in children, although the risk of severe disease is lower in children than adults with the original variant.
The experience of other countries will affect Malaysia similarly as our Covid-19 situation is among the worst in Asia.
The number of positive cases in our country has exceeded two million.
In the global league of cumulative reported cases, Malaysia was in 21st position on Sept 13 (2021), up from 39th on May 31 (2021) and 85th on Nov 18, 2020.
The number of daily cases and daily deaths per million population has exceeded that of India, Indonesia and the Philippines – the only Asian countries with more cases than Malaysia.
Malaysian schools have been severely disrupted since the Covid-19 pandemic began more than 18 months ago.
With the re-opening of schools, parents have understandable concerns.
Some of the considerations I have personally shared with patients, family, friends and colleagues are below.
Vaccinate or test
While students aged 12 and above are eligible to receive the Covid-19 vaccine, younger ones are not, thus the adults around them should be fully vaccinated to help protect them. — AZHAR MAHFOF/The Star
Every person in a classroom or childcare centre with an infected person is at risk of infection, as sharing air is the major mode of viral spread.
Children often get infected by adults around them.
As such, vaccination of adults in a child’s household or daycare centre, teachers and everyone that a child comes into contact with at school, can help protect children.
An unvaccinated teacher who had symptomatic Covid-19, read to primary school students in Marin County, California, US, without a face mask on, contrary to the school’s requirements.
The infection was spread to the students with an attack rate of 80% (i.e. eight out of 10 were infected) in the two rows seated closest to the teacher’s desk and 28% (four out of 14) in the three back rows.
The latter was indicative that 1-2m physical distancing may not be sufficiently protective.
Some people may not be vaccinated because of medical conditions or personal choice.
The school is responsible to ensure that they are tested for the SAR-CoV-2 virus regularly and that there is no contact between them and the children.
Mask mandates
Face mask mandates have been part and parcel of the Covid-19 standard operating procedures set by the National Security Council (NSC).
It is important that the face mask is of high quality and fits the child’s face.
Double masking and the use of a face shield are preferable.
The children have to understand the reason they have to wear a mask, e.g. “when we wear a mask, the virus cannot jump from one person to another”.
However, the Health Ministry’s guidelines state: “Masks should not be worn by children younger than two years old, anyone who has trouble breathing and anyone who is unconscious, incapacitated or otherwise unable to remove the cloth face covering without assistance.
“Masks should not be shared.”
Schools have a responsibility to ensure that those who do not wear face masks do not come into contact with the children.
Hand sanitisation facilities
Hand sanitisation facilities, i.e. handwashing, or alternatively, alcohol hand rubs, are among the requirements at workplaces, which should also be applicable to schools.
The Education Ministry has to ensure that schools have adequate hand sanitisation facilities for the number of students they have.
If not, then it has to be rectified.
Children have to understand why hand sanitisation is necessary, e.g. “clean hands stop the spread of infections”.
Facilities to wash hands with soap or the provision of alcohol hand sanitiser should be widely and easily available in all educational institutions. — Filepic
Ventilated classrooms
It is now generally accepted that the spread of the SARS-CoV-2 virus is primarily airborne.
Air circulation in well-ventilated classrooms will reduce any viral load in a room.
Classrooms can be ventilated by the opening of windows – the ideal would be two windows at opposite ends of a room.
If there is only one window, a fan can move out any polluted air.
If the opening of windows is not possible, portable air purifiers can reduce the viral load in a classroom.
While ventilation guidelines have been issued by the NSC, there are no reports on its monitoring and compliance.
The relevant ministries have to remember that control of Covid-19 is the joint responsibility of everyone.
Reducing indoor numbers
Many classrooms are packed with students, particularly in the public sector.
Reduction of the number of people in a classroom can reduce the risk of Covid-19 spread.
This can be done by having the children attend school physically and learning virtually on an alternating basis.
This approach, when combined with face masks, has been shown to reduce viral spread in university campuses.
The use of outdoor spaces for lessons, where practicable, is another approach.
Although the Delta variant can spread outdoors, the risk is much less.
Testing schoolchildren
The availability of self-testing kits, if utilised judiciously, will help reduce viral spread.
Saliva tests are a practical testing method, but the cost of these self-test kits has to be taken into consideration.
Whether or not to test schoolchildren is a policy decision.
In order to reduce overcrowding in classrooms, students can rotate between going to school and studying online.
Sick children
When a child is sick, parents should not send the child to school.
Instead, medical attention should be sought.
The child should not attend school until (s)he has fully recovered.
This will prevent the spread of any infectious disease, including Covid-19, in school.
Childcare centres
A study has reported that children up to three years old spread Covid-19 more than older children.
Although, this report may be an outlier, the vaccination of parents and childcare staff are vital in preventing spread in childcare centres.
Except for face-masking, the measures discussed above can easily be used in childcare centres.
Takeaways
As Covid-19 spread in schools reflects community spread, it is crucial that all necessary measures are taken to limit community spread to ensure schools can be safe for all students.
Prior to sending their children back to school, it would be prudent for parents to verify and confirm with the school management what measures have been put in place to ensure the safety of all students.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
