As countries respond in very different ways to the pandemic, so too is there great variety in how state and territory governments are planning for children’s return to school, as public health researcher Alison Barrett reports in her latest column.
Global overview
In the ten weeks since the Omicron variant was identified, almost 90 million cases of COVID-19 were reported – more than the total number of cases reported to the World Health Organization (WHO) in all of 2020.
The Director General of the WHO, Dr Tedros Adhanom Ghebreyesus cautioned last week:
We’re concerned that a narrative has taken hold in some countries that because of vaccines, and because of Omicron’s high transmissibility and lower severity, preventing transmission is no longer possible, and no longer necessary.
Nothing could be further from the truth.
More transmission means more deaths. We are not calling for any country to return to so-called lockdown. But we are calling on all countries to protect their people using every tool in the toolkit, not vaccines alone.”
On a similar note, Dr Maria Van Kerkhove, WHO’s technical lead on COVID-19, said:
Now is not the time to lift everything all at once.
We have always urged – always urged – caution in applying interventions as well as lifting those interventions in a steady and in a slow way, piece by piece.”
Denmark is one of a handful of countries, including Sweden, Norway and Finland, that have removed or are planning to remove all pandemic restrictions by the beginning of March 2022.
While still experiencing more than 40,000 new COVID-19 cases each day, Denmark has high vaccination coverage and has seen a decline in the number of patients in intensive care (ICU) since 6 January. As Danish hospitals are no longer overwhelmed, COVID-19 is not considered a socially critical disease anymore, according to Professor Michael Bang Petersen, adviser to the Danish Government on COVID policy.
Denmark’s vaccine coverage is similar to that in Australia, with 81 percent of the total population double-dosed, compared to Australia’s 79 percent. However, a higher proportion of their population has received a third dose (61 percent of Denmark’s total population, compared to 33 percent of Australia’s total population).
Comparison of COVID-19 vaccine doses, new cases, ICU patients and confirmed deaths between Denmark and Australia, as of 7 February 2022. Source: ourworldindata.org
In contrast, South Korea, with similar vaccination coverage and number of ICU patients as Denmark, has extended their COVID-19 restrictions amidst a spike in cases, even though the number of COVID-19 deaths is lower in South Korea than Denmark.
Comparison of COVID-19 vaccine doses, new cases, ICU patients and confirmed deaths between Denmark and South Korea, as of 7 February 2022. Source: ourworldindata.org
This highlights that each individual country considers their own local context, such as political factors, socioeconomic status, social and healthcare system capabilities, when determining ways to move forward through the pandemic.
As Emeline Han and colleagues wrote in The Lancet in 2020: “When and how a country should ease restrictions are the common challenges that governments worldwide now face as they seek to balance various health, social, and economic concerns.”
While it is promising that many countries are experiencing high vaccination coverage and a manageable burden on their healthcare system, it is important to acknowledge the unequal vaccine distribution across the globe.
Only 10 percent of people in low-income countries have received at least one dose of a COVID-19 vaccine. Some countries, including the Democratic Republic of Congo and Yemen, have vaccinated less than two percent of their populations.
Source: ourworldindata.org
Australian inequities
Promisingly, Australia appears to have passed the peak of the Omicron variant wave, with overall COVID-19 case numbers, hospitalisations and deaths declining.
Despite this, some individuals and communities, such as those in aged care and Aboriginal and Torres Strait Islander people, are continuing to feel the impacts of the Omicron wave.
Queensland reported 24 deaths in the past 24 hours, the highest number of COVID-19 deaths in the state in one day during the pandemic. Sixteen of the state’s deaths were recorded in aged care facilities.
The Aboriginal Medical Services Alliance in Northern Territory (AMSANT) has calculated that NT currently has the highest rate of hospitalisations per capita in the country.
While Chief Minister Michael Gunner said he is confident NT’s healthcare system is prepared to handle the likely increase in ICU patients, AMSANT is concerned that it will not be able to manage.
Central to the concerns are the low third-dose vaccination rate in NT, that ninety percent of patients with COVID-19 in NT hospitals are Aboriginal people, and that many people living in remote Aboriginal communities are unable to self-isolate sufficiently.
Aboriginal communities have been calling for Federal Government action to support them through this wave of the pandemic, and OzSAGE has also consistently raised concerns.
Challenging start to the school year
During the week of 31 January, the first term of school began in some form in all Australian states and territories except Queensland and Tasmania. Queensland schools returned on 7 February and Tasmanian schools return on 9 February.
In a format that differs to other states and territories, South Australia started the first two weeks of term with a hybrid online/face-to-face learning model, where key year groups (pre-school, reception and years one, seven, eight and 12) were learning on-site and the other year groups were learning online.
This format is intended to continue until 14 February, when all students will return to onsite learning.
While an increase in COVID-19 infections in children across the country in the first few weeks of school is expected, face-to-face learning is optimal for children’s education and COVID-19 is generally less severe in children than in adults.
However, it is important that all measures are in place to ensure the learning environment is safe, limited spread of COVID-19 occurs, disruptions are minimal, and vulnerable students, such as immunocompromised or disabled, are sufficiently supported.
A statement by UNICEF Executive Director Henrietta Fore last week called for schools worldwide to stay open with appropriate measures in place, such as mandatory vaccination of educators and other school staff.
Understandably, the return to school during a time of significant community transmission is worrying for families, children and educators.
University of Sydney infectious diseases epidemiologist Associate Professor Meru Sheel told the ABC: “This is probably the first time we’ve been in this situation – previously in that Delta wave period from about August to October, people were in lockdown and that was mostly remote or learning from home.
“So, this is the first time [in Australia] people are accepting and coming to terms with the fact that we have community transmission.”
Families and educators raised concerns about starting the school year before the five to 11-year-old group could be sufficiently vaccinated, as the vaccination rollout for this age group only began on 10 January 2022.
By 31 January, 45 percent of five to 11-year-olds in Australia had received their first COVID-19 vaccine dose. As the Australian Technical Advisory Group on Immunisation (ATAGI) recommends eight weeks between first and second doses in this age group, many children will not have received their full vaccination schedule until at least March.
On the other hand, with memories of online learning over the past two years during lockdowns, particularly for those in Melbourne, some look forward to studying onsite this year.
Although all states and territories are encouraging vaccination in students, it is not mandatory for them to be vaccinated to attend school.
It is essential that educators have the appropriate support and systems in place to carry out their role, while protecting their own health, their families and their students.
Educators’ workloads are already high and impacted by shortages of teachers, that are “not equally distributed across the state [of NSW, but also relevant to other states] but strongly reflect the socioeconomic profile of the schools”, education consultant John Frew wrote in John Menadue’s Public Policy Journal.
In a media release early last month, the Australian Education Union (AEU) criticised the Federal Government for the lack of a national plan for returning to school, and the lack of government consultation with educators about the plans.
“Critically, the teaching profession, through the AEU, must be consulted on the development of the national plan. We stand ready to work constructively with all governments,” AEU federal president Correna Haythorpe said in the release.
Similarities and differences
Each state and territory’s plan for the first four weeks of term is similar in that limited interaction should occur between year groups, use of natural and mechanical ventilation is recommended and outdoor learning is encouraged.
In all states and territories, educators and school staff need to have had at least two doses of a COVID-19 vaccination by the beginning of term one. Victoria and Western Australia have mandated that a third dose is required for educators and school staff within one-month of eligibility, which should be by no later than 25 February.
However, some differences occur between the states and territories in their implementation and application of rapid antigen testing regimes and mask mandates.
Australian Capital Territory and New South Wales’ schools are following a similar plan, by providing eight rapid antigen tests per student and asking parents to test their child/ren twice a week for the first four weeks of term as a surveillance method. Staff are recommended to do the same.
It is not mandatory and negative results don’t need to be reported. Positive results should be reported to NSW and ACT Health departments and to the school, and the student or staff should isolate for at least seven days, or following current government health advice at that time.
All staff and high school students are required to wear a mask when indoors, and primary school students in years three to six are encouraged to wear them.
For more information about NSW school plan, read ‘Advice for families.’
ACT Education Department answers some ‘frequently asked questions’ here.
Similar to NSW and ACT, Victorian schools will be distributing RATs to students and strongly recommending testing twice per week for the first four weeks of the term.
Due to higher risks associated with COVID-19 for some students with disabilities, the Victorian Government recommends that students and staff at specialist schools undergo voluntary testing five times a week.
Different to NSW and ACT, all Victorian students from year three and above will be required to wear masks.
Additionally, the Victorian Government has invested heavily in air purifiers for classrooms, with intended delivery of 51,000 air purifiers prior to term one.
More detailed information about Victoria’s back to school plan can be viewed here.
Tasmania’s first term begins on 9 February, with face-to-face learning as priority. Each student will be provided with two rapid antigen tests before the term begins and then two per week per student to use if they have symptoms.
The Tasmanian Government made the decision not to undertake surveillance testing, as is being done in NSW, Victoria and ACT, due to the lower level of community transmission in the state.
Masks will be mandatory for all adults and secondary school students. Primary school students will not be required to wear a mask.
Tasmania’s plan also acknowledges the needs of vulnerable students, such as those with disability and complex health needs, advising that individual learning plans will be updated if required.
A COVID-19 care pack will be provided to students including two RATs, surgical face masks and health and wellbeing information for families.
Tasmania’s ‘return to school’ plan can be viewed here.
Similar to Tasmania, Queensland and South Australia will not be undertaking surveillance testing in schools, except in early learning years in SA.
The South Australian Education Department is strongly recommending surveillance testing in early learning centres and preschool education staff, with SA’s Chief Public Health Officer Professor Spurrier saying: “There’s very little risk mitigation that you can do in those settings, so the evidence shows that if you are going to use rapid antigen tests in those screening or surveillance modes, then you have to do it at least three times a week or every second day.”
Neither Queensland or SA will be providing school students with rapid antigen tests prior to the school term.
In primary and secondary schools, as part of a ‘test-to-stay’ approach, SA students who are close contacts of a positive COVID-19 case will need to undergo a test every day for seven days. They can attend school as long as the test results are negative.
South Australian teachers will be provided RATs if a student tests positive for COVID-19, and they will need to undergo testing every day for seven days, similarly being permitted to attend school if the test results are negative.
Masks are required for all adults and students in years seven to twelve.
South Australia’s COVID-Safe measures for schools can be read here, and more detail about the testing regime in schools can be read here and early years here.
In Queensland, rapid antigen tests will be provided to students or staff if they develop symptoms at school. If symptoms are developed outside of school hours, staff and students will have priority collection at Queensland Health testing clinics.
All adults and students in years seven to twelve are required to wear a mask.
Queensland’s back to school plan can be viewed in more detail here.
Northern Territory’s return to school plan is similar to Tasmania’s, with the exception of increased protection for remote communities.
School staff in remote communities will be provided with three RATs to use in the week that they return to community. Staff can also participate in voluntary surveillance by testing themselves three times a week during school term.
Remote schools will be prioritised with delivery of portable air purifiers if they do not have central air conditioning.
The Western Australian school year began on 31 January. Education staff are required to be double-dosed by the start of the term, and receive their third dose within one month of becoming eligible.
Masks will be mandatory for staff and secondary school students. If/when high levels of community transmission of COVID-19 occur, masks will become mandatory for students in years three and above.
On 28 January, WA’s Education and Training Minister Sue Ellery and Community Services Minister Simone McGurk announced new definitions for close contact in school and childcare settings which will influence testing protocols, that will take effect when WA reaches a high level of community transmission.
All back-to-school plans will be reviewed after the first four weeks and revised as needed.
First week back
Schools in NSW remained open during their first week of the school term last week, even though 2,400 students and hundreds of educators tested positive for COVID-19. Staff absentees were managed effectively, the NSW Education Minister Sarah Mitchell said in the Sydney Morning Herald.
In contrast, and emphasising the disproportionate impact COVID-19 continues to have on Aboriginal and Torres Strait Islander communities, schools in the Far West and APY Lands of South Australia were closed last week, contending with the dual issues of floods and community outbreaks of COVID-19.
Further reading
Test all students and staff twice a week, or only close contacts? States have different school plans – here’s what they mean: Professor Fiona Russell and Professor Robert Booy provide a detailed discussion in The Conversation about the evidence for surveillance testing (as in the ACT, NSW and Victoria) and test-to-stay (as in SA). Ultimately, “the decision on which strategy to take depends on context, including workforce issues and the level of community transmission, and the availability of sufficient quantity of RATs,” they wrote.
Back to class: public school COVID protocols ‘full of holes’: John Frew analyses NSW back to school protocols in last weeks’ edition of Pearls and Irritations.
Children and schools the new flashpoint as experts do battle online: Interesting discussion in The Sydney Morning Herald about the differing views of experts in public health, paediatric health and infectious disease, surrounding children and schools.
OzSage recommendations for making schools and childcare safer
How Denmark Decided COVID Isn’t a Critical Threat to Society: Derek Thompson, writer at The Atlantic, interviewed Professor Michael Bang Petersen, adviser to the Danish government on COVID-19 policy, about the removal of pandemic restrictions in Denmark.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
