By Dr Despina Demopoulos a paediatric intensivist at the Wits Donald Gordon Medical Centre. #VoicesThatCare

If you haven’t read it already, please see part 1 of this series in which we analyse the risks versus the benefits of sending children back to school during the COVID epidemic. The benefits largely outweigh the risks and thus it is important for us to ensure that schools are safe as far as possible.

How can we ensure the environments at schools are safe, with less risk of transmission?

  1. Masking, physical distancing, and hand hygiene.
  2. Non-pharmacological interventions(NPI) including:
      • engineering controls – (what we can do to the environment), such as ensuring ventilation and sufficient space;
      • administrative controls – (what we can arrange), such as staggered time-tabling, screening, hand hygiene, cough etiquette and appropriate environmental cleaning;
      • personal protective equipment(PPE) –(what we can wear), such as cloth face masks and eye protection visors.

Recommendations for a safe return to school

schools are safe

SAPA supports the position that children should attend school as long as is safely possible.
Most children, including those with asthma, allergic conditions and HIV can attend school. Only children with severe medical conditions may be safer at home. These include children with severe immunosuppression, uncorrected significant congenital heart conditions, chronic organ failure, chronic severe respiratory disease and severe neurodevelopmental disability. Advice from relevant healthcare professionals should be sought if there is uncertainty.

Early Child Development (ECD) settings promote physical health, emotional safety, social connections and engaged learning. Reopening ECD settings can provide children with much-needed emotional support, learning opportunities and offers reliable childcare options for parents returning to work.

However, children with limited mobility (who cannot avoid coming into close contact with others nor practice preventative measures), and those with cognitive impairment or difficulty understanding the importance of practicing preventative measures, may be at increased risk of acquiring Covid-19 infection and may be safer at home. Each case should be individually evaluated by the treating doctor.

School protocols for COVID-19:

SYMPTOM SCREENING
Symptom screening should be undertaken at school entry each day. Children can have their temperatures taken on arrival at school but the benefit of this is probably minimal because a feverish child will usually have other symptoms. Learners, teachers and other staff should not go to school if they have ANY SYMPTOMS. These include:

  • fever,
  • cough,
  • runny nose,
  • sore throat,
  • diarrhoea and/or
  • vomiting..

It should, nevertheless, be recognised that most children (and many teachers) will be asymptomatic during SARS-CoV-2 infection.

WHAT IF SOMEONE AT HOME HAS COVID?
Children who are well but who have an infected household contact should remain at home for 10 days from the last significant contact with the infected person. There should be no requirement for children to have a negative SARS-CoV-2 test before being allowed to return to school.

WHAT IF MY CHILD’S CLASSMATE IS FOUND TO BE COVID POSITIVE?
Children who have a SARS-CoV-2 infected classroom contact – defined as close contact (less than 1.5 m) with an infected learner or teacher for 15 or more minutes – should be advised to stay at home for 10 days. They should be monitored for symptoms and if any occur a COVID swab should be performed.

IF MY CHILD HAS COVID SYMPTOMS, WHAT NOW?
If a child develops symptoms of COVID-19 disease, he/she should be tested. If negative, with no contact history, he/she can return to school immediately once asymptomatic. If positive, or if no testing is done, the child must remain at home for 10 days from the onset of his/her symptoms (see National Institute of Communicable Diseases guidelines).

WHAT IF WE HAVE A HIGH RISK PERSON IN THE FAMILY?
Children with high-risk individuals at home (such as the elderly) should be advised to reduce contact time with them and do this more safely (e.g. wearing a mask during contact time), with more vigilant attention to home cleansing, and developing a home routine that minimises risk such as limiting the sharing of towels and kitchen utensils.

COVID-19 will continue for the foreseeable future, with infection rates increasing and decreasing in waves. Children are much less likely than adults to become severely ill with COVID-19 and are also less likely to transmit SARS-CoV-2 (coronavirus) to their contacts. Not attending school has profound negative consequences, including detrimental effects on education, nutrition, mental and physical health, and finances. As paediatricians we advise that attending school is beneficial to children, their parent(s) and the broader community.

References available in the SAPA Statement.

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