As the Trump administration pushes for schools to reopen even as the US records daily record new infections, the experience of other countries where classes have resumed seems ever more important. So what lessons have been learned?
Is it safe?
So much about coronavirus is still unknown, but the thrust of the emerging evidence is that people under the age of 18 are less likely to contract the virus (somewhere between a third and half according to some studies) and that the risk of severe illness is much more remote.
There is some suggestion too from outbreaks around the world that younger children pose less of a risk of driving an infection cluster than older pupils, but the evidence is inconclusive.
One serious cause of concern is that Covid-19 can seriously sicken some children. A pan-European study, published in the Lancet last month found that while fatality in children who catch the disease is “substantially lower” than in older adult patients some children do develop severe cases of the disease.
The recent conclusion by the World Health Organization – under pressure from scientists worldwide – that the virus can be transmitted airborne in enclosed spaces has also changed perception of the risk.
Have infections in schools driven resurgences of infections in the community?
This is one of the big unanswered questions.
While there is evidence that the way Israel reopened its schools (see below) may have driven a resurgence of cases, the issue is muddied by the fact that schools reopened at the same time as other social gatherings were allowed.
Different countries have interpreted risk in different ways, meaning that there has been no consistent approach, while perceptions of appropriate social behaviours in different countries – not least the resistance to restrictions and mask wearing in significant parts of the US – also make it difficult to compare experiences.
What evidence is there that schools can be reopened safely?
Two countries that have been cited for their positive experience in school reopening without a significant increase in infections are Norway and Denmark, which started reopening schools for younger children about a month after they closed with small classes, improved sanitisation and social distancing.
In Denmark pupils are divided into micro-groups of about 12 students who arrive at a separate times, eat lunch separately, stay in their own areas of the playground and are taught by one teacher with sufficient physical distance between students and teachers.
How have other countries reopened schools?
A very useful literature review – a Summary of School Re-Opening Models and Implementation Approaches During the COVID 19 Pandemic – was published by Brandon Guthrie and colleagues at the beginning of July.
The paper suggests, that in general most countries that have reopened schools “have instituted some degree of staggering the start, stop, and break times within the school” and a “number of countries are using alternate shifts (morning, afternoon) or alternate days, while a smaller number of countries have maintained relatively normal school schedules”.
It adds: “More countries have reopened only for younger students than have reopened only for older students … [with] systematic school-based testing for SARS-CoV-2 virus or antibodies being done on a small scale in a limited number of settings, but this approach is not widely implemented at this time.”
One country that has seen limited testing to monitor potential outbreaks in schools is Germany, where students have been assigned individual desks kept some six feet distant, with seating locations logged for future contact tracing. Some schools are testing every four days, with those testing negative being allowed to attend without a face mask.
What about face masks for schools and other transmission control measures?
According to Guthrie and his colleagues, the use of face masks has been required in Belgium, France, Germany, Israel, Japan, South Korea, Taiwan and Vietnam while other countries, (including Belgium, Denmark, France, Germany, Greece, South Korea, Norway and Switzerland) have focused on reduced class size to approximately 50% capacity.
Other countries where class size has not been reduced are relying on the closure of schools with confirmed cases or increasing physical distancing between pupils.
Where has it gone wrong?
In Israel – currently experiencing a second peak that has seen restrictions reimposed –clusters linked to schools that followed the country’s reopening at the end of May have been cited as a factor.
Among the most serious was the Gymnasium Rehavia in Jerusalem where 153 students and 25 staff were infected in late May and early June. Other schools, including in Canada and New Zealand, have experienced outbreaks.
Israel initially followed the same approach to small class sizes, before lifting restrictions, a move that led to infections in multiple schools, leading to closures and other quarantine measures affecting some 1% of school population.
A comparative study on the approaches of Finland And Sweden two largely comparable countries that introduced very different regimes came to the conclusion that “closure or not of schools had no measurable direct impact on the number of laboratory confirmed cases in school-aged children in Finland or Sweden.”
Another study found that very few of 2,000 schoolchildren and teachers tested in the German state of Saxony showed antibodies to Covid-19, suggesting schools may not play as big a role in spreading the virus as some had feared.
Germany began reopening schools in May, though debate continues as to the role children may play in spreading the virus to vulnerable adults at home as well as to older teachers and school staff.
The study by the University hospital in Dresden analysed blood samples from almost 1,500 children aged between 14 and 18 and 500 teachers from 13 schools in Dresden and the districts of Bautzen and Görlitz in May and June.