MALAYSIA, like countries all over the world, is in the midst of a global education crisis. The Covid-19 pandemic has put one billion children out of school. To about 400 million children with no access to free school meals, this means missing out on their only decent meal of the day. Children living in abusive households have now lost the safe havens provided by their teachers and friends at school.
Schools are an integral component of local communities. Reopening schools and keeping them open today is one of our greatest challenges as advocates of child education, health and welfare.
Clinical studies have shown a strong correlation between the frequency of Covid-19 outbreaks in schools and the incidence of the disease in the community. If infection in the community is optimally suppressed, there will be a minimal number of cases among the school teachers and pupils.
But if there is an upsurge in the community cases, as is happening now, with sporadic, unlinked and widespread community transmission, it rapidly spills over into the schools, which makes it difficult to keep them open.
Therefore, it is vital to stop the transmission of the coronavirus in the community in order to prevent the spread of Covid-19 into the schools.
School clusters comprise 5.5% of the total clusters, but this is rapidly increasing. Studies show that two-thirds of coronavirus transmissions in schools occur between teachers and from teachers to pupils. Teachers must therefore be exemplary, cautious, and not huddle in the staff room, which should by now have cubicles to ensure physical distancing.
To stem the spread of Covid-19, all schools must adopt mitigation measures and the standard operating procedure (SOP) as mandated by the Education Ministry and advocated by members of the Malaysia Paediatric Association. The latter gave specific improvements on the ministry’s SOP to encourage the 3Ws (Wash hands, Wear mask and Warn) and how to avoid the 3Cs (Close conversation, Confined spaces, Crowded places) for students, teachers and the administrative staff.
Apart from encouraging outdoor learning (indoor transmission is 18 times higher than outdoors) and ventilating classrooms etc, one other pivotal intervention is the practice and strict adherence to class bubbles. These bubbles represent cohorts of staff and pupils to limit mixing with other classes and age groups. These are best school practices to help reduce the sporadic transmission of the virus by keeping the same children and the same staff together.
The formation of these small class bubbles will facilitate the management of a positive Covid-19 case, which would only involve the isolation of the index case and the testing and quarantine of the affected class. This strategy will not impact other classes or the whole school, which can operate as usual.
For the affected class, alternative teaching, namely online, should be commenced and continued until the class is cleared to join formal face-to-face teaching in the school.
In this respect, clear and detailed step-by-step written instructions should be provided to parents on what to do when their children are exposed. Ideally, a hotline should be installed that would allow parents to contact the school for further clarification and advice.
If a child in the class had only minimal exposure, remained asymptomatic and tested negative, his other siblings at home should be allowed to attend school, and parents should not be quarantined either. Pre-emptive closure of schools should only be a last resort. And these should only be undertaken when the baseline community spread is excessive and exceeds a threshold incidence as pre-determined by public health experts who are fully cognizant of the burden and impact of viral transmission within the community.
The “Red Zone” concept is an idea plucked from the air by the Health Ministry and is not founded on sound incidence and prevalence of Covid-19 data. Data Science, Artificial Intelligence and Machine Learning incorporated within available digital apps are more reliable in this aspect.
The UK’s NHS Covid-19 app has played an invaluable role in “identifying areas at greater risk of a growth in cases and/or where restrictions on social and economic activity are successfully helping bring infections under control”. Its independent Scientific Advisory Group for Emergencies (SAGE)'s Final Integrated Find, Test, Trace, Isolate, Support (FTTIS) response to the pandemic report should be looked at and enhanced for use locally. A zero-Covid-19 modus operandi targeted at maximum suppression of the virus is the best approach to prevent infections in schools, thus protecting our teachers and school children.
At the local level, empower school heads to make local decisions deemed suitable for their school environment. The “one size fits all’ and “Health Ministry knows all” mindset needs rethinking.
The headmaster is part of a committee/virtual team comprising state Education Department officers and state Health Department clinicians with seamless communication so that school heads could get 24 hours advice and become competent at troubleshooting Covid-19 issues in their schools.
The school-based health team in charge of each district (ideally one in each heavily populated school) should be activated to monitor the situation on a regular basis and act promptly in concert with the school heads when positive cases are detected.
Real-time data should be shared with all schools so that the school authorities are up to date and can reassure parents that the school ambience is safe.
Since the early reports from China, severe Covid-19 disease and associated mortalities continue to remain rare in children. In the United States, United Kingdom, Italy, Germany, Spain, France and South Korea, Covid-19 deaths in children up till February 2021 was estimated at 0.17 per 100,000 population. It only comprised 0.48% of all-cause deaths. The evidence indicates that children continue to be spared, mostly but not completely, the worst outcomes of the coronavirus.
Nevertheless, the collateral damage to their learning, growth, psychological health, socio-development and etc has been devastating. Many of the gains we made from the MDG (Millennium Development Goals) and SDG (Sustainable Development Goals) have been either reversed or lost!
Prior to the pandemic, 400,000 households were living below the poverty line (RM2,280) in 2019. This translates to about 1.2 million affected children. This pandemic will push an additional two to three million into serious poverty.
Unicef reports that 37% of B40 families in Kuala Lumpur are struggling to put food on the table.
The National Health and Morbidity Survey (2019) showed that 21.8% of our children are stunted and many attend school with no or only irregular breakfasts. This pandemic will most certainly worsen childhood malnutrition with its long-term consequences for growth and neuro-development. We must ensure food security for these children through an effective social safety net.
On the other hand, the movement control order (MCO) with decreased physical activities have led to overweight and obese children. A survey by the Education Ministry of about 900,000 students revealed that 37% of them do not have any appropriate learning devices. Only 6% to 9% of students own a personal computer. Even if a household has a personal computer, many would have to share this with other members of the family for work or study. This undoubtedly would negatively impact e-learning and contribute to the regression of their learning abilities.
The digital divide must be immediately bridged, with devices and the Internet made more accessible to poorer families. More strategically, keep schools open as much as possible.
There is documented evidence that domestic violence and child abuse have increased during the MCO period. Social services need to be strengthened. More importantly, the opening of schools presents a respite to these abused children.
The prolonged and fearful pandemic would inevitably have a negative impact on the mental health of our children. This may range from phobia and fear syndromes to obsessive-compulsive disorders (OCD) and post-traumatic stress disorders (PTSD), which are often invisible to the casual eye.
Companionship and friendship at school are part of a child’s natural social environment and are essential for their normal psychological development and well-being. Children under 18 years old make up 29% of the Malaysian population (2018). This means that virtually all adult Malaysians must be immunised to attain herd immunity to protect our children who are presently not eligible for the vaccines. This would seem a herculean undertaking considering that 35% of our adult population are either hesitant or refusing any form of immunisation.
To ensure our schools remain open and the education of our children is not interrupted, all teachers and school administrative staff should be prioritized in the upcoming phase two of the National Immunisation Programme.
If you take away schools and all the essentials of child nurturing away from them, then you would have a generation of children whose future will forever be scarred.
DR MUSA MOHD NORDIN
DR ZULFLI ISMAIL