By Dr Jo Neary
By 18 March 2020, 107 countries implemented national school closures in response to the corona virus pandemic. Much of the knowledge regarding the utility of school closure in pandemics comes from previous modelling of influenza pandemics. A rapid review of evidence1 described two such pieces of evidence: the UK Department of Health’s commissioned report, and a 2018 systematic review of impact of school closure on influenza transmission2,3.
Both reports found evidence that school closure could reduce transmission among school-aged children, although the Department of Health report offered the caveat that closures impacted on reduction of peak cases rather than in cumulative attack rates.
Despite strong evidence regarding stemming the spread of influenza through school closure, the evidence is mixed regarding the value of doing so with Covid-19. Currently, evidence to support national closure of schools to combat Covid-19 is weak1, particularly given the apparent low clinical effect on school children.
Younger children ‘may have lower incidence of Covid-19’
There is much the scientific community does not know about to the role of children as a source of infection, and whether they can transmit it4,5. What has been observed, is that younger children may have lower incidence of Covid-19 than adolescents, and children are more likely to be asymptomatic. However, given the lack of biological data pertaining to children and Covid-196,7, there can be no clinical certainty regarding children and young people and the spread of the virus, particularly in relation to those children who are asymptomatic.
Given the uncertainty around children and Covid-19, schools that have re-opened have done so cautiously, often involving moderate social distancing interventions4. As pupils are not exposed to routine checks in schools, it is likely that the policy regarding school reopening will follow the wider population incidence rates.
However, re-opening schools has been described as a calculated trade-off between the risk of Covid-19 and the exposure of increased inequality and poverty for children and their families8. School closure for a long period of time risks detrimental effects on the social wellbeing and health of children living in poverty, as it’s likely to exacerbate existing inequalities which in turn has an impact on their ability to learn (e.g. food insecurity, unstable housing, the lack of space at home to work, lack of access to laptop or internet to engage in online learning, etc.).
Plans for lifting lockdown in schools are heterogeneous across Europe, providing a ‘patchwork of approaches and timetables, a vast laboratory for how to safely operate an institution that is central to any meaningful resumption of public life’9. Below, we detail three such heterogenous responses to re-opening schools in France, Germany and Denmark, all of which are mindful of the ongoing issues of social distancing and the need to ensure the virus is contained.
Lockdown in France lifted on 11 May, initially focusing on primary and middle schools, although since 2 June, all schools have re-opened for the last month of school before the summer holidays. The emphasis in France has been on primary schools returning, with secondary schools only able to go back in areas where the virus was not widely circulating10.
Initially parents voiced concerns regarding returning to school, and as a result, the first three weeks of schooling were not compulsory to allow parents to observe the low risk of school return. This is reflected in the relatively low initial uptake of schooling, where 1 in 5 pupils returned to school, although the pupil attendance rates have risen steadily since then. As of 22 June, attendance will become compulsory, and all home schooling will require to be registered through the local authority11.
Initially, social distancing in France was 4m, although this has now reduced to 1m10. Within the school grounds, they have introduced measures to keep pupils safe. For example, reducing the number of children in classrooms to 15, having staggered arrivals at school, and ensuring toys are not shared. Classrooms were subject to social distancing measures. with no more than 15 children in class at one time, no shared toys (including footballs) or contact sports, and a staggered arrival at school. Teachers and pupils over the age of 11 are expected to wear masks12.
Similar to France, the re-opening of schools began with primary schools on 15 April for pupils between 2 and 11, with older pupils (aged 11+) being allowed to return to school from 22 May. Initially parents were concerned about pupils returning to school, so attendance was not compulsory. However, over time, attendance rose steadily as parental confidence increased.
Like Scotland, Denmark had a social distancing policy in place (2m), although this has now reduced to 1m from 7 May (and has been reduced to zero for early years provision) although they believed this alone would not be enough to keep pupils safe, particularly with young children. In primary schools, teachers created “protective bubbles” whereby micro-groups of pupils arrived at different times of day, ate lunch together, had a separate zone of the playground, and were taught by one teacher. This bubble consisted of between 10-12 pupils13.
The model used required the division of classes and increased the number of teaching staff to cover the need. In some schools, the bubble was smaller for outside play, limiting interactions to groups of four14,15. Games should not involve shared equipment (such as balls) and should be non-contact.
A lynchpin of the approach has been the focus on hand hygiene in the classroom, and sterilising objects that are likely to be touched by many individuals (such as desks, door handles, etc.)16
The vice president of the Danish Union of Teachers suggested that one of the key mechanisms for returning pupils to school safely was having the trust of society in their government and authorities, a feeling boosted by the transparency and collaborative nature of decision making, between local authorities, government, and teacher trade unions13,17.
Trade unions were allowed to access scientific knowledge and modelling to guide their school opening negotiations with the Danish government.
Unlike Denmark and France, Germany initially reopened secondary, rather than primary and early years, schools. This was partly driven by the necessity of secondary pupils to sit their exams (similar to A-level or Higher)18.
Given the devolved nature of education in Germany, each state has its own roadmap for returning to full schooling. Therefore while there is a plan in some states to return to full schooling (early years, primary, secondary) before the summer holidays, many head teachers have described that this many not be possible, given the challenges of social distancing measures, and staff shortages.
Secondary school pupils and teachers are required to wear protective facemasks when in communal areas of the school building, in line with national health strategies17. Like other contexts, pupils are taught in smaller designated groups during the day, with regular breaks for handwashing. The school day is mixed, with classroom and online learning.
When in the classroom, pupils share the room with up to 10 pupils. Classes are divided into two, with half pupils attending one day, and the other half the next. However, time in school is also shorter sometimes only two to three hours per day. In the playground, zones have been marked to ensure pupils do not mix more than necessary19.
Each state can set its own rules. As such, some areas have lowered the social distancing to 1.5m, while others have remained at 2m20.
Some schools have removed sport and music lessons as they are considered a greater risk to the spread of the virus.
Other comments: the geography of the school
Classroom size is a factor for schools working out what to do with space. For example, in Denmark, primary and lower secondary share the same school building, which allowed for more space during the period where there was a staggered return to school If all pupils returned to the classroom at the same time, it would have been difficult to find that 2m space to separate learners’ desks. Where space is at a premium, classes may have to be repeated various times to the different clusters of learners.
Also, in all contexts, one clear policy has been advocating for a one–way system through the school, which reduced the number of pupils in the corridor at any one time. Where there is an open-plan building, it is unclear how such a policy could be implemented.
Dr Jo Neary is a research associate with the NSEE team based at the University of Glasgow. Her research interests include how social policy influences people’s experience of neighbourhood, education, and health; and the role of education in developing supportive systems for young people.
Follow her on Twitter @joanne_neary
1. Viner, R.M., Russel, S. J., Crocker, H et al (2020) School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review Lancet Child and Adolescent Health 4 (5) 397-404
2. Jackson, C., Mangtani, P., Vynnycky (2014) Impact of school closures on an influenza pandemic: scientific evidence base review Public Health England: London
3. Nafisah, S. B., Alamery, A.H., Nafesa, A et al (2018) School closure during novel influenza: a systematic review Journal of Infectious Public Health 11 657-661
4. Di Domenico, L., Pullano, G., Sabbatini, C.E. et al (2020) Expected impact of reopening schools after lockdown on COVID-19 epidemic in Ile-de-France. Pre-print Accessed online [22/06/2020] https://www.medrxiv.org/content/10.1101/2020.05.08.20095521v1
5. Armitage, R., Nellums, L. B. (2020) Considering inequalities in the school closure response to COVID-19 Lancet Global Health 8 (5) e644
6. Ludvigsson, J. F. (2020) Children are unlikely to be the main drivers of the COVID-19 pandemic- a systematic review Acta Paediatrica Online pre-print [accessed online 22/06/2020] https://onlinelibrary.wiley.com/doi/full/10.1111/apa.15371
7. Munro, A. P. S.., Faust, S. N (2020) Children are not COVID-19 super-spreaders: time to go back to school BMJ Archives of Disease in Childhood 105 (7)
8. Van Lancker, W., Parolin, Z (2020) COVID-19, school closures, and child poverty: a social crisis in the making Lancet Public Health 5 (5) e243-244
15. Bell, I., Chapman, C (2020) Reopening of schools in Denmark Policy Scotland briefing paper https://policyscotland.gla.ac.uk/wp-content/uploads/2020/04/PSBriefingPaperReopeningOfSchoolsInDenmark.pdf