The dangers of going back to school after coronavirus

Europe has two problems when it comes to reopening schools.

First, there’s weighing the risks of opening the gates again against the potential damage done by keeping them closed, whether to economic recovery or mental health. Even more challenging may be convincing anxious parents that now is the time to send their children back to school.

As Europe counts the cost of nearly four months of the coronavirus pandemic, governments are having to make the call.

It’s “one of the most difficult things” for policymakers, said Russell Viner, president of the Royal College of Paediatrics and Child Health. “It’s an impossible balancing task.”

With no easy answers, Europe hasn’t been able to settle on a consistent approach. Germany began reopening schools in April, with older students returning first. In England, it’s the opposite, with primary schools poised to begin reopening in June.

“We need to think about the risks of both opening schools and keeping them closed to children, parents, teachers and support staff” — Martin McKee, professor at the London School of Hygiene and Tropical Medicine

In Belgium this week, those in the final years of primary and secondary school began to return to school. Italy and Spain, on the other hand, are treading much more cautiously and only reopening schools in September.

To complicate matters, parents aren’t always on board with their government’s plans. Over 500,000 Britons have signed a petition calling for the right to opt out of sending their children back to school. In Denmark, when schools began to reopen in April, some parents kept their children at home, saying they didn’t want them to be “guinea pigs,” Reuters reported.

And it’s not just the children who need to be considered.

“We need to think about the risks of both opening schools and keeping them closed to children, parents, teachers and support staff,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine.

The kids are all right

What all governments are scrutinizing is the science, which they hope will tell them whether it’s safe to reopen schools.

When the coronavirus first emerged, it quickly became clear that children were relatively unscathed.

“In every major country, children have been very little affected by COVID-19 if you looked at the overall picture,” said Viner, speaking at a press briefing on May 13. In China, the U.S., Italy, the Netherlands, Spain and the U.K, only around 1 to 2 percent of total coronavirus cases have been in those aged under 18, he noted.

But in late April, as many governments planned their school reopening schedules, there was a new twist: a rare inflammatory disease affecting some children.

The emergence of the syndrome, described as Kawasaki-like, prompted the World Health Organization (WHO) to declare an “urgent need” for more data on the illness. The WHO also said it’s “temporarily” linking the syndrome to COVID-19, “based on initial laboratory testing showing positive serology in a majority of patients.” 

But to experts such as Viner and Liz Whittaker, clinical lecturer in pediatric infectious diseases and immunology at Imperial College London, the fact that the syndrome is so rare should mean that it shouldn’t influence decisions to keep children at home.

“The risk of getting severe COVID-19 in young children remains extremely low, despite this serious condition, which will affect very few,” said Whittaker at the same May 13 briefing. “It shouldn’t be a factor … when decisions are made about when and how to reopen schools.”

The risk of super-spreaders

Policymakers aren’t just considering whether children get the virus, but how easily they may spread it — a reasonable fear given previous evidence of children being super-spreaders of illnesses such as influenza and measles.

“That’s my biggest fear,” Michael Hoelscher, head of infectious diseases and tropical medicine at Munich University Hospital, told the New York Times.

But the (limited) evidence doesn’t support this.

Ireland’s Health Information and Quality Authority has reviewed the data and found that from the small number of studies identified, “children are not, to date, substantially contributing to the household transmission of SARS-CoV-2.”

The one study that analyzed transmission in schools also showed very low spread, although the review admits that the “evidence remains limited.”

The WHO’s chief scientist, Soumya Swaminathan, told the BBC’s “Andrew Marr Show” on May 17 that it seemed that “children are less capable of spreading it even if they get the infection.”

But it’s this lack of evidence that was cited by the British Medical Association, the U.K.’s doctors’ union, when it supported the country’s National Education Union in its opposition to reopening schools before it deemed it safe to do so, reported the Guardian.

“Large national decisions [are] not optimal in these situations given variance within a country” — Devi Sridhar, chair of global public health at the University of Edinburgh

McKee, at the London School of Hygiene and Tropical Medicine, thinks it is “premature” to reopen schools in the U.K. as the country’s testing system is “problematic” and its contact-tracing system “untested.”

And some U.K. local authorities are ready to take matters into their own hands and refusing to reopen their schools, just as some mayors in France did earlier in May.

Devi Sridhar, professor and chair of global public health at the University of Edinburgh, believes that local-level data on levels of transmission and daily new cases is needed to inform these decisions.

“This puts information directly into [the] hands of key members of the educational community,” she wrote on Twitter. “Large national decisions [are] not optimal in these situations given variance within a country.”

Widening inequalities

When to reopen the schools has been the “most delicate” issue, said Marius Gilbert, head of the Spatial Epidemiology Laboratory at Université Libre de Bruxelles and part of the group advising the Belgian government.

It’s not just the risk of transmission increasing, Gilbert told L’Echo. He warned of another danger – that of children being cut off from all social life and being deprived of the structure that school gives them.

Harry Quilter-Pinner, senior research fellow at the Institute for Public Policy Research, agreed, calling this “probably one of the biggest disruptions we’ve faced in the last 100 years in terms of education and schooling.”

For Quilter-Pinner, the key concern is the widening of the attainment gap, which is the concept that children in deprived areas do worse than their wealthier counterparts.

Indeed, data on England from the Institute for Fiscal Studies finds that during the outbreak, students from wealthier families have been spending more time on home learning and have better access to individualized resources such as private tutoring. Their parents also feel better able to support them.

But the problems don’t stop when schools reopen.

“The challenge of reintroduction is not just how do you get people back into classrooms,” said Quilter-Pinner. “It’s how do you build on what was normal to recover and get back to where we were before.”

Returning to school will require significant logistical challenges, with the need to maintain social distancing and have fewer children in a class, he noted.

Risky business

“As a society, we have choices to make,” said Quilter-Pinner, such as addressing how big the risk of reopening schools is and whether we are willing to take that risk.

“In any case, you will have to learn to live with the virus” — Marius Gilbert of Université Libre de Bruxelles

Alastair Sutcliffe, professor of general pediatrics at University College London, said these decisions are based on considerations of “various known risks.”

“One of the few positive things to come out of COVID is that it very rarely kills children, especially very young children, especially healthy young children,” he said, adding that in reopening schools, we need to consider this very low risk versus other potential risks to children from not returning to school.

With no clear end to the pandemic in sight, schools will have to be reopened at some point, say experts like Gilbert at Université Libre de Bruxelles: “In any case, you will have to learn to live with the virus.”

James Randerson and Carmen Paun contributed reporting. 

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