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Infectious Diseases

Updated 14 August 2020

'Unequivocally, as a paediatrician and a parent, I believe schools should be open' - Prof Glenda Gray

A continuing wave of public school closures across the country is not a good idea, for several reasons, says Professor Glenda Gray.

  • Schools have closed amid Covid-19 infection concerns.
  • Several studies show that children are not flagged as high risk during the Covid-19 pandemic.
  • However, they can still transmit the virus, so key precautions should be in place in school environments.

Last month, President Cyril Ramaphosa announced that all public schools would "take a break" for four weeks (27 July–24 August), News24 reported. He said the government believed it was critical to ensure that schools were not breeding grounds for the coronavirus as infections surged in the country.

However, while closing schools can contribute to the flattening of the curve, continuing school closures beyond this may do more harm than good, according to Professor Glenda Gray, president and CEO of the South African Medical Research Council (SAMRC) and a member of the Ministerial Advisory Committee (MAC). She spoke on Thursday during the 2020 Thought-Leader Webinar Series on health and modelling during Covid-19, hosted by the University of Free State.

"Unequivocally, as a paediatrician and a parent, I believe schools should be open," said Gray.

Children largely spared from contracting severe Covid-19

Most Covid-19 data suggest that children are largely spared from infection, severe disease and outcomes. This happens for a number of reasons, including their innate immune systems, the fact that they have lower viral copies than adults, and reduced ACE2 receptors (the "doors" that allow SARS-CoV-2 to enter the body's cells).

However, Gray acknowledged that it didn't mean that children didn't play a role in virus transmission. As they get older, they will gain higher viral copies and will be more likely to transmit the virus.

"And so it's very important, in terms of the challenges of schools, to consider the parents', teachers' and the children's households. A lot of South African households are intergenerational, and we know that the elderly and those with comorbidities are more likely to have adverse outcomes or severe disease and even die," said Gray.

To combat the risk, Gray advised that steps be taken to "de-risk" the schooling environment as much as possible. She said this could be done by implementing non-pharmaceutical interventions (NPI).

These interventions include physical distancing, face mask-wearing, thorough handwashing, and sufficient ventilation in classrooms, such as ensuring that school windows are constantly wide open. 

Consider older teachers and those with comorbidities

More than the above, Gray said older teachers and those with comorbidities should be kept out of direct contact with children.

"We also know from our experience with healthcare workers that the place where virus transmission happens is usually in the tea room, where teachers take off their masks and chat and don't pay attention to NPI. And so we have to minimise the transmission that happens in tea rooms," added Gray.

Link between school closure and depression

Children need to return to school for several reasons. One of these is the risk of developing depression.

"We've seen a lot of depression [in children] at a global level, said Gray. "They've been deprived of stimulation; they haven't had access to school nutrition. If you look at the risk-benefit, children should be allowed to go to school."

This study, for instance, found that depression and anxiety symptoms among children in Grades 2 to 6, were common after one month of school closures in Hubei Province, China.

Authors of another study published in The Lancet also wrote that school routines were important coping mechanisms for young people with mental health issues, and that when schools are closed, "they lose an anchor in life and their symptoms could relapse".

Depending on their grade, by early August, South African children will already have lost between 30 and 59 days of school, Servaas van der Berg, Professor of Economics and South African Research Chair in the Economics of Social Policy, wrote in an article in The Conversation.

Virus transmission more common in communities than in schools

"From the data I've seen, schools play a very small role in the transmission of the Covid-19 virus and a lot more transmission happens in the community and via commuting, in overcrowded taxis and in crowded containment," said Gray.

Another significant reason to continue the education programme is that children are less likely to continue their schooling careers the longer they remain out of school, particularly those from low-income households, according to Gray.

Among SA medical experts in favour of the reopening of schools is Professor Heather Zar, a paediatric pulmonologist.

During a News24 Frontline panel discussion in June, Zar weighed in on the issue.

"Getting the flu is a higher risk than getting Covid-19 for kids," Zar said, adding that the virus was far more likely to spread in an office or grocery store than in a school and that children are more likely to contract the virus from their parents.