As Victoria and New South Wales move towards reopening schools and overseas experience highlights the risks for schools that all jurisdictions can expect to face, all possible measures should be taken to protect students from transmission of SARS-CoV-2, according to public health researcher Alison Barrett.
Evidence-based guidelines suggest implementing a range of measures, including mask-wearing, physical distancing, hygiene, ventilation and vaccination, she reports.
In her latest COVID-19 wrap, Barrett also highlights some differences in the approaches between NSW and Victoria.
Alison Barrett writes:
As Victoria and NSW move towards their roadmap out of lockdown, both states have revealed their plans for the reopening of schools.
The new premier of NSW, Dominic Perrottet, announced changes to the roadmap on 7 October 2021.
NSW will begin staged reopening of schools on 18 October with the return of kindergarten, year 1 and year 12 students to schools. All remaining year groups will return on 25 October (**this was previously slated for 1 November, but brought forward a week earlier on the 7th October).
All staff and students in year 7 and above will be required to wear a mask indoors and outdoors unless exercising or eating, and primary school students are strongly recommended to wear a mask indoors.
NSW teachers will be required to be fully vaccinated against COVID-19 from 8 November 2021.
You can read the NSW Government roadmap to reopening schools here.
Concerns have been raised about the lack of guidelines surrounding ventilation in NSW schools (here and here, for example).
By contrast, the Victorian Government’s roadmap, the ‘Three Vs’, include guidelines about “ventilation, vaccination and vital COVIDsafe Steps” for a safe return to school.
In “the biggest investment in education ventilation in Australian history to be rolled out across Victorian schools”, the Victorian Government is providing funds for air purification systems, and shade sails to facilitate more outdoor learning options.
As discussed by Dr Elysia Thornton-Benko in Croakey, no national plan for ventilation appears to exist, so it is promising the Victorian Government plans to address this.
On 22 September, Victoria’s Chief Health Officer, Professor Brett Sutton, announced that staff in schools and early childhood settings will be required to be fully vaccinated against COVID-19, by 29 November 2021.
Other COVIDSafe measures in Victorian schools are mandatory mask-wearing for all adults and secondary school students, staggered pick up and drop off times, QR code check in for essential visitors and physical distancing where possible.
Minister for Education James Merlino said: “I know Victorian families can’t wait to see their kids back in the classroom – but we need to keep them safe once they’re there, and we’re delivering ventilation devices to prevent as much transmission on school sites as possible.”
More details about Victoria’s staged return to school can be read here.
In acknowledging the impact the pandemic has had on school-aged children, the Victorian Government announced on 4 October 2021 that all Victorian secondary schools would be funded to have a qualified mental health practitioner.
What the experts say about schools and COVID-19
School reopening without robust COVID-19 mitigation risks accelerating the pandemic
Gurdasani, D et al., The Lancet, 27 March 2021
It is important for children to be able to attend school on-site for social development, mental and physical wellbeing, and education. However, all schools need to be safe for that to occur.
If schools reopen without proper protection measures in place, they risk widespread transmission of SARS-CoV-2, resulting in sick children and staff, in addition to community lockdowns, school closures and/or absences due self-isolation requirements.
In the UK in 2020, when schools were open, almost one-quarter of secondary school children were unable to attend due to self-isolation during times of high community transmission.
As discussed in a previous COVID-19 Wrap, the long-term impacts of COVID-19 on children are not well understood, but studies indicate that children can suffer long-COVID as per adults. This is another important reason to do all possible to protect children from COVID-19 at school.
These are not new warnings or recommendations. Among others, Dr Zoe Hyde, has been advocating for the protection of children in schools since 2020.
She wrote in the The Medical Journal of Australia in November 2020:
There is clear evidence that children and schools are at risk, with wider implications for the community. Additionally, serious outcomes in children will become increasingly common – at least in absolute terms – if the virus is allowed to spread.
We can no longer afford to overlook the role children play in transmission if we hope to contain the virus.”
Transmission in schools during the pandemic
COVID-19 in schools and early childhood education and care services – the experience in NSW: 16 June to 31 July 2021
National Centre for Immunisation Research and Surveillance, 8 September 2021
NSW schools that remained open for students who required on-site attendance during the current outbreak have not remained free from the virus, according to a report prepared by the Australian National Centre for Immunisation Research and Surveillance (NCIRS).
Between 16 June and 31 July 2021, primary COVID-19 cases were identified in 59 people (34 students and 25 staff) from 51 different educational settings in NSW, including schools and early childhood education centres. Secondary cases linked to these were identified in 106 people related to 19 of the 51 education settings.
The highest rate of transmission was between school staff members, and in early childhood education centres located in the LGAs with highest level of community transmission.
In an indication of what may happen when schools reopen in Australia, since the beginning of the school year in Canada in September 2021, many schools across the country have experienced outbreaks, with many closing temporarily.
On 6 October 2021, CBC News Canada reported that 54 schools in the Alberta province were currently experiencing outbreaks of the virus (which they define as 10 or more cases linked to one investigation).
Similarly, in England, school attendance decreased in the week between 16 and 30 September (approximately two weeks after school resumed for the year) as 2.5 percent of all students were not able to attend due to COVID-19 related reasons.
Meera Senthilingam, Croakey editor and global health journalist, discussed more examples of transmission in schools and school-aged children in her piece, ‘As we open up, the evidence is clear: protect children’.
She also wrote about an exemplar model for successful reopening in San Francisco, where, since schools reopened in April 2021, “only seven instances of in-school transmission have been identified”.
This is being attributed to high vaccination rates in children over the age of 12 years, addition of High Efficiency Particulate Air (HEPA) purifiers to improve ventilation in classrooms and mask-wearing for all children over the age of two years.
The California Government recently announced that once vaccines are approved for different age groups, COVID-19 vaccination will be mandatory for schoolchildren.
Gavin Newsom, Governor of California, tweeted the below on 2 October, 2021:
Recommendations for protecting children at school
Protecting children from COVID-19 and making schools and childcare safer
OzSage, 1 October 2021
Protecting children with vaccines is one recommendation outlined in OzSage’s recent publication.
The Australian Technical Advisory Group on Immunisation in Australia recommends that all individuals 12 years or older be vaccinated against COVID-19. Results from the Pfizer trial in 12 to 15-year-olds were discussed in a previous COVID Wrap.
Clinical trials for vaccines in children younger than twelve years are ongoing, and it is likely results from the trials will be available before the end of 2021.
Additional recommendations by this group include improving ventilation in indoor school rooms and for everyone five years or older to wear masks. They recommend that two to five-year-old children should wear masks where developmentally appropriate.
They also highlight the importance of providing support for the social and mental health of children and their families, and that access to education and safe workplaces is equitable.
The full report and recommendations can be viewed here. OzSage’s recommendations are consistent with the US Centers for Disease Control and Prevention (CDC) guidelines for preventing COVID-19 in K-12 schools.
Evidence for improving ventilation in schools
Testing mobile air purifiers in a school classroom: reducing the airborne transmission risk for COVID-19
Curtius, Granzin & Schrod, Aerosol Science and Technology, 01 Mar 2021
Aerosols are very small particles that can remain suspended in the air for long durations, and one of the main ways in which the SARS-CoV-2 virus is transmitted. Reducing the concentration of the virus in the air via improving ventilation is one method to reducing the risk of virus transmission in schools.
Because schools are typically high-density indoor environments, it is important to determine optimal options for improving ventilation during, and beyond, the pandemic.
A study exploring the effect of mobile air purifiers, in particular with HEPA filters, on aerosols in school classrooms found that they are an effective strategy of reducing the concentration of SARS-CoV-2 in classrooms.
Acknowledging some challenges in using air purifiers (such as noise, and cleaning and maintenance), the authors wrote that, “after two hours, the concentration of aerosol particles containing virus RNA in the room is more than 10 times higher without purifiers compared to with purifiers.”
While they should not replace other measures to reduce virus transmission, such as hygiene, physical distancing and mask wearing, as recommended by OzSage, air purifiers should be considered as an additional method to keeping children safe at school.
Evidence for wearing masks in schools
Association between K-12 school mask policies and school-associated COVID-19 outbreaks – Maricopa and Pima Counties, Arizona, July – August 2021
Jehn, M et al., Centers for Disease Control and Prevention, Press release, 1 October 2021
An American study exploring the association between mask wearing policies at schools and outbreaks found that schools without an early mask requirement in Arizona state were 3.5 times more likely to experience an outbreak than schools with an early mask requirement.
The study was conducted between 15 July and 31 August 2021, at the start of the American school year.
The study defined an early mask requirement as a mandate that was in place at the time the school year began. An outbreak associated with a school was defined as two or more confirmed cases of COVID-19 among students or staff members of a school.
Of the 999 schools that were included in the study, 21 percent had an early mask requirement, 30.9 percent implemented a mask requirement within 17 days of school starting, and 48 percent did not have a mask requirement.
During the study period, 191 outbreaks occurred at schools included in the study: 8.4 percent in schools with early mask requirements, 32.5 percent in schools with late mask requirements and 59.2 percent in schools with no mask requirement.
While the authors did not have access to vaccination information or other potential causes for the outbreaks (such as inadequate room ventilation), the study provides a strong indication of the benefits of implementing a mask mandate in schools.
In conclusion, while on-site learning is important for children’s social and educational development, it is evident that schools should (and be enabled to) do all possible to protect students from transmission of SARS-CoV-2.
Evidence-based guidelines suggest implementing a range of measures, including mask-wearing, physical distancing, hygiene, ventilation and vaccination, will help reduce the risk of COVID-19 in schools.
Resources for safe schools during the pandemic
- School ventilation: a vital tool to reduce COVID-19 spread
Johns Hopkins Center for Health Security, May 2021 - 5 step-guide to checking ventilation rates in classrooms
Harvard T.H. Chan School of Public Health, 2021 - Healthy schools: risk reduction strategies for reopening schools
Harvard T.H. Chan School of Public Health, November 2020 - CDC’s guidance for COVID-19 prevention in K-12 schools
Centers for Disease Control and Prevention, Updated August 2021 - Protecting children from COVID-19 and making schools and childcare safer
OzSage, 1 October 2021 - Schools have moved outdoors in past disease outbreaks. Here are 7 reasons to do it again
The Conversation, 11 October 2021
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.
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