Introduction by Croakey: Primary school students, and their home-schooling parents, are no doubt looking forward to the upcoming school holidays.
But plans to send this largely unvaccinated group back to NSW classrooms next term are concerning and many questions remain, writes Dr Elysia Thornton-Benko, a Sydney GP, researcher, and mother to three children (two in primary school and one in high school).
Elysia Thornton-Benko writes:
With many NSW school students coming to the end of a term of online learning, what is the rationale for NSW primary school children returning to onsite learning next term, just weeks before the end of the 2021 school year?
As a Sydney GP working in a practice involved in the vaccination rollout, my work life is filled with COVID-19 conversations and keeping up to date with the dynamic situation. My two primary-school aged children are currently schooling from home.
Unlike high-school students, who have the opportunity to be vaccinated (although there may be variable access) before returning to school, most primary school children will not be eligible for vaccination before returning to classrooms.
In Australia, since the beginning of the pandemic to the 16 September 2021, according to National Notifiable Diseases Surveillance System (NNDSS) data, there have been more than 8,800 COVID-19 cases in children aged nine years and under, and more than 10,500 cases in 10-19-year-olds.
The Delta variant is more transmissible than earlier variants and is infecting children and the unvaccinated in large numbers in Australia and globally. COVID-19 has become a disease of the unvaccinated.
During this current Delta wave, one in three cases in NSW have been in children, and up until 16 September, there has been one death in 10-19-year age group.
Most COVID-19 acute cases in children are mild, which is reassuring. However, some children do become seriously unwell. Australian NNDSS data (1 January to 1 August 2021) shows a hospitalisation rate in children 0-19 years of age of 2.5 to 3%. These numbers are not insignificant, especially when there are high levels of community cases as is currently the situation in NSW.
The recent National Centre for Immunisation Research and Surveillance report (16 June to 31 July 2021) showed that the transmission in schools was five times higher for Delta than for previous variants in 2020.
However, the study occurred during a holiday and lockdown period, so conclusions regarding transmission and risk in schools when operating during normal capacity cannot be made. The study also occurred at a time when cases in NSW and Australia were significantly lower than the current national caseload of more than 18,500 cases.
Long COVID risks
Research recently published in The BMJ found that one in seven children and young people had symptoms (mainly headaches and fatigue) at 15 weeks after COVID-19 infection.
The BMJ authors noted that this figure was lower than some other studies, which had reported a prevalence of Long COVID of up to 51% in children and young people.
There are a few studies being published globally, with varied results. The main point is that studies differ in their quality of data and unknowns remain. It is an area that needs further high quality data and surveillance.
Opening up
The NSW Government’s 70 percent vaccination target to ease restrictions excludes children aged under 16 years, despite them being about 20-25 percent of the overall Australian population, according to the Australian Bureau of Statistics.
There are varying levels of vaccination coverage throughout NSW, with lower rates in some lower socioeconomic areas and among some groups.
Vaccination equity is key when decisions are being made that affect a whole state and have national implications.
COVID-19 vaccination trials in the younger age groups are occurring with preliminary data expected within weeks.
A prominent epidemiologist wrote in The Medical Journal of Australia recently that “to assume that COVID-19 will continue to be a mild disease in children is to fail to adjust to responses based on knowledge gained earlier in the pandemic”.
“We must appreciate what we do not yet know and be prepared to adapt.”
The writer encouraged the vaccination rollout to include adolescents and young adults. This is now the case, yet children under 12 remain unvaccinated.
What’s happening overseas?
The American Academy of Paediatrics reported that there had been more than 750,000 cases in children between 5 August and 2 September 2021.
The authors stated: “At this time it appears that severe illness due to COVID-19 is uncommon among children. However, there is an urgent need to collect more data on longer-term impacts on the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects.”
Expert recommendations
The recently formed Australian independent expert group OzSAGE is providing evidence-based guidance on Australia’s pandemic management with specific recommendations regarding the current Delta outbreak.
The group has recommended that vaccine targets be met for all population subgroups including Aboriginal and Torres Straight Islander people, remote populations, and others at high-risk and whom are deemed vulnerable, including children.
OzSAGE also has made recommendations regarding indoor air/ventilation to support the safe reopening of Australia, especially with regards to indoor environments.
The importance of ventilation, access to carbon dioxide meters, and filtration systems has also been emphasised by various professionals, including from experts at UTS.
However, at the time of writing, there is no national nor NSW school ventilation plan.
Remote learning challenges
While there are some positive outcomes from online learning – such as parents/caregivers gaining insights into their children’s school life, students showing resilience and adaptability, and teachers developing innovative ways to communicate and collaborate – there are downsides.
Children have experienced mental distress with more calls to the Kids Helpline and supportive services, although not all are necessarily related to remote learning.
Older students have particularly felt the impacts of examination stress and social isolation from their peers.
As recently reported in Croakey, vulnerable groups are also at a significant disadvantage, especially those living in poverty or with disability, as well as those in rural and remote areas.
Educational impacts
Professor Jenny Gore of the University of Newcastle recently conducted research comparing pre- and post-lockdown testing and found that on average, primary school students did not suffer “learning loss”.
This is reassuring and is supported by data out of Victoria regarding years three and five students after the 20-week lockdown last year. The latest National Assessment Program – Literacy and Numeracy (NAPLAN) results also found that the pandemic had no significant impact on achievement on a national or state level.
While students from disadvantaged backgrounds are likely to be more negatively impacted, these children can be supported with “evidence-backed programs and initiatives”.
Urgent questions
Under the current NSW return-to-school plan, the youngest students will begin to return to classrooms from 25 October, with other school years following over the next 1-2 weeks. Students from some of Sydney’s Local Government Areas of concern, however, may have to continue remote learning if case numbers don’t drop.
Face masks will be “strongly recommended” for primary school students and vaccination will be mandatory for NSW teachers from 8 November 2021.
Many questions about the return to school plan remain, including the lag time between students returning to class and the requirement for teachers to be vaccinated:
- While mask wearing is sensible, how many five to nine-year-olds will tolerate a mask for an entire school day?
- How will social distancing and “reduced mingling” be monitored? Such regulations are likely to be distressing for children, especially the younger ones.
- What ventilation and HEPA type air filtration plans will be implemented? Will indoor air testing be occurring?
Additionally, what plans are in place for primary school children with chronic health conditions, such as asthma and diabetes, that increase their risk of developing more serious COVID-19? “Cocooning” our unvaccinated children with vaccinated others is key, and yet this is challenging to manage and likely to prove difficult under various circumstances.
Socialisation and face-to-face engagement are important, and on-site school can also be a safe-haven for children with less-than-ideal home circumstances. However, we have been managing remote learning now for many weeks with support systems in place.
Risk-benefit balance
It’s important to weigh up the benefits of just a few weeks of face-to-face learning – with multiple restrictions and many activities not permitted – against the potential risks to children, including the risk of Long COVID.
We must also consider that any increase in COVID-19 cases among children will come at a time of expected stress on an already strained health care system.
Would it be wise to wait for the soon-to-be released data on vaccines for younger cohorts and for a consistent plan for students – at least those in Greater Sydney – to all return to face-to-face learning at the start of the 2022 school year?
We have a duty of care to protect our future generations. It is crucial we get the next steps right!
Dr Elysia Thornton-Benko is a Specialist GP and a UNSW Research Fellow.
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