Re-opening schools and preventing spread of COVID-19 : A Primer | Daily News


Re-opening schools and preventing spread of COVID-19 : A Primer

School assemblies should not be held for some time
School assemblies should not be held for some time

Part - 2

The Sri Lanka College of Paediatricians (SLCP), the foremost academic professional organization of all the Consultant Paediatricians in Sri Lanka, forwards this Position Statement regarding the reopening of schools to optimize adaptation of children to the new normal situation during and following the COVID-19 pandemic and to prevent the spread of the disease when mobilization of children accelerates alongside the reopening of schools and other educational institutions. The exact timing would depend on many considerations and the status of COVID-19 in the country at various times.

2.1. Maintenance of social distancing (Continued from yesterday)

2.1.4 Continue the use of e-learning and distance learning facilities

This is a very good opportunity to assess the availability and utilization of e-learning and distance learning facilities in schools. Many schools are already conducting virtual class rooms during the period of school closure. Continuation of these activities facilitates bringing children to schools on different dates to prevent congestions in schools and class rooms.

Although, a significant proportion of schools in Sri Lanka, particularly those in rural areas, do not have these facilities, it is imperative that the State should intervene immediately to reduce the gaps in affordability of these facilities and ensure equitable provision of such resources.

At the same time most of the rural schools that do not have these e-learning facilities may be in a position to conduct daily classes because they have adequate space to conduct open air classes, and they may be placed in extremely low risk areas with regard to potential COVID-19 spread.

Therefore, these measures should be adjusted according to the available facilities and degrees of risk for spread of the disease according to the local epidemiological data.

2.1.5 Avoid mass assemblies at schools as much as possible. It is best to avoid them completely in the initial phases of reopening of schools. Use public announcement systems maximally (if available) to convey messages to students. Otherwise convey all messages through the teachers.

2.1.6 Impose restrictions on sports, extra-curricular activities and off-school hours activities appropriately during the initial phase.

2.1.7 Provide intervals for different sections in different time slots to minimize contacts of children during intervals.

2.1.8 Avoid reopening of school canteens during the initial phase.

2.1.9 Minimize sharing of books, other school items and food articles among children as much as possible during the initial phase.

2.1.10 School hostels would be places which have potentially higher risks of spreading the virus. The facilities available to maintain social distancing and other essential practices are very variable among hostels of different schools and hence, we strongly recommend that school authorities should liaise with the local health authorities to make necessary arrangements before reopening schools to prevent potential disease spread within hostels.

2.1.11 Private tuition classes should be temporarily suspended during the initial phase because most of them do not have adequate space to maintain social distancing. Teachers of mass scale tuition classes should liaise with the local health authorities before commencing private tuition classes when permission is given by the government to commence private tuition.

2.2 Facilitate correct and regular hand washing facilities at schools

2.2.1 Provide adequate places with running water and soap or hand washing liquids to implement hand washing by students.

· This should be arranged before reopening of schools and could be done with the support of parents, past pupils, private donors or any other reasonable source. We hasten to reiterate that this is an essential pre-requisite for reopening of schools.

· The number of hand washing places should be adequate and a method should be implemented to prevent students gathering in large numbers at these places which could increase contact among them and negatively affect the principles of social distancing.

2.2.2 Teaching and demonstration of correct hand washing technique by the teachers.

2.2.3 Paste diagrams or pictures of correct hand washing technique which the children can easily see while they are washing hands.

2.2.4 Make a list of instances where hand washing is mandatory such as each time they enter the classroom (minimize going out of the class room), before taking meals and after adjusting face masks.

2.2.5 Appoint student monitors to implement regular hand washing and facilitate student groups to monitor each other and provide some rewards as incentives to promote this practice.

2.3 Use of face masks by school children

The SLCP categorically supports and strongly recommends the wearing of face masks by school children in Sri Lanka as a means of protecting children from COVID-19, in addition to all other protective measures, in the process of resumption of routine day-to-day activities including reopening of schools and other educational activities. The risk of potential harm due to wearing face masks by children is negligible if they are trained to use the masks properly. Face masks do not limit the effectiveness of breathing with ordinary activities whereas strenuous physical activities and group playing are anyway restricted during the initial period to reduce social contacts. The declared possibility of ‘strangulation’ by the mask is a figment of a rather colourful imagination. Collective evidence shows that when everybody in the community use masks even if some do not wear them properly, this practice significantly reduces the overall spread of the virus than when people are not wearing them.

However, we emphasize that parents, teachers and all adults should make sure that children wear face masks in a proper way as far as possible.

According to the instructions given by the WHO regarding correct use of face masks, the following steps should be followed.

* Wash hands with soap and water or clean hands with alcohol based hand rub before putting on a mask.

* Cover the nose and mouth with the mask without keeping gaps between the face and the mask.

* Avoid touching the mask while wearing it and if someone does so, then there is a need to wash or clean hands immediately.

* Remove the mask from behind without touching the front when removing it, discard it according to the instructions and wash or clean hands immediately.

One of the main concerns regarding recommendation of masks to be worn by children is that they may touch the mask despite instructions on not to do so. Face masks prevent children from touching their nose and mouth frequently as it acts as a face cover too and it’s better than them touching their face.

2.3.2 Sri Lanka College of Paediatricians forwards the following suggestions on wearing face masks by children. SLCP supports that every school child should wear a face mask throughout school time and also while going to and from schools. (It is practically impossible to keep at least one metre distance between the students throughout school time and hence, full-time face masks being worn from the start to the end of school is strongly recommended). Children above 2 years may use masks whenever possible if they travel outside home for any reason, if it is difficult to keep to the recommended social distancing requirements.

However, the SLCP does not encourage very young children to be taken out of home except under essential and compelling circumstances as mortality and morbidity related to Covid-19 in this age group is relatively high. During the initial period once schools are reopened, priority should be given to train children on the way of living in a new normal style in the context of COVID-19 pandemic. This should include laying emphasis on the proper use of face masks and the correct way for donning and doffing of the masks to take meals and drinks during school time. should be encouraged to use not only the surgical mask but homemade or purchased cloth masks for children. It is essential to educate them through the mass media about the correct use and reuse of the masks. Reusable cloth masks should be washed thoroughly with soap and water daily after use. Some alternative methods of disinfection of used face mask such as use of steam may be available in the future. Children should not discard used face masks at schools under any circumstance and parent should give a paper bag or other suitable container to each child to bring the mask back home if it is required to discard the mask during school time for any reason. In addition, parents should provide an extra clean face mask to every child to be used at schools if such a situation arises. should be advised properly and very strongly on refraining from sending children with fever, respiratory symptoms or any other acute condition causing ill health to schools until that condition resolves satisfactorily. Parents and local manufacturers should be encouraged to make masks with different sizes and this will improve the quality of the masks that would properly fit children in different age groups. main purpose of encouraging the wearing of masks by children is to protect ‘others’ from asymptomatic children carrying the virus. Children are 2000 times less likely to die from Covid-19 compared to those above 60 years. However if there are vulnerable children like those who are immuno-compromised or those with co-morbidities, ways of providing them with facilities for distant learning or e-learning with state support is strongly recommended.

If these vulnerable children have reasons to attend school, they will have to wear not a cloth mask or a surgical mask but a N95 Respirator mask as the primary aim should be to protect them from others. Such patients with chronic conditions are more likely to know how to wear a mask as they have been using them before and how to keep it properly than those who have to wear a mask for the first time with school reopening.

3. Make use of this situation in a positive way: Potential additional long-term benefits of the measures to prevent spread of the disease among school children

3.1 Long-term prevention or reduction of all respiratory infections in children.

Utilization of this opportunity optimally to train children to follow correct hygienic practices including cough etiquette as mentioned above, not only with the objective of controlling and preventing the current COVID-19 problem, but also as a general measure targeting the prevention of all other respiratory infections, would be a most desirable bonus.

Respiratory infections, particularly upper respiratory tract infections such as the common cold, are the number one reason which necessitates children to seek and need medical attention and hospitalization. In addition, it is the commonest reason for school absenteeism in children. Hence, the social environment which has been created by the COVID-19 pandemic is an ideal opportunity to train children in proper hygienic practices which would have long-term positive implications and benefits.

As much as there has been a reduction of the number of respiratory infections presenting to hospitals during school closure, school reopening may be expected to increase all contagious diseases in the community.

Hence, training of children to continue these good health measures and avoiding getting infections by reducing unnecessary social encounters would be a valuable long-term investment.

3.2 Laying the foundation to categorize components of individual syllabi according to the current situation as mentioned above and planning for a long-term revision of school syllabi to reduce the undue burden on children would be a very beneficial exercise.

3.3 Identification of e-learning and distance learning as additional supportive measures for classroom teaching and gradual provision of more facilities to optimize the use of this facility alongside the development of modern technology in the future would be a most desirable development towards educational progress in the future.

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