With no clear evidence that closing schools significantly reduces community transmission or overall deaths, as paediatric doctors we urge the government to open schools to all learners and not to allow fear or politics to harm the children of South Africa.
Children’s risk to acquire Covid-19 is lower than adults
Children and young people have a lower susceptibility to the novel coronavirus, SARS-CoV-2, with 56% lower odds of being an infected contact. Data released by the National Institute for Communicable Diseases (NICD) from March to July 29 indicates that only 6% of confirmed Covid-19 cases in South Africa occur in children aged 0 to 18, despite the fact that children make up a third of the population.
Children’s risk of school and community outbreaks is low
Evidence from international studies points towards very limited spread between children with few reported large outbreaks in schools in any country. This supports the argument that asymptomatic children attending schools are unlikely to be significant spreaders of the disease.
The reopening of schools had not resulted in any major outbreaks. In the schools that have reported a case, 72% reported only or or two. In the Western Cape more than half of the schools have not reported a single positive case despite high community transmission in the province at the time.
As of July 16, there were only 333 (0.8%) active Covid-19 cases among Western Cape Education Department staff, indicating that teachers are not at greater risk than other essential workers. Weekly new staff cases have been decreasing since the reopening of schools despite ongoing high community transmission rates.
Children’s risk for serious disease or death is extremely low
Studies from China, Italy, the United Kingdom and the United States report very low numbers of critically ill and deaths in children in the under-19 age group, with children experiencing a much milder disease than adults and deaths being extremely rare.
By July 25 only 3% of all Covid-19 cases in children required admission to hospital in South Africa and only 26 (0.08%) Covid-19 related deaths were reported in children aged 0 to18.
SARS-CoV-2 has caused less childhood deaths when compared with influenza since the onset of the pandemic. Research from seven high income countries on 42 846 confirmed paediatric Covid-19 cases showed 44 Covid-19 deaths versus 107 influenza paediatric deaths during the current pandemic.
South African children remain at greater risk of death as a result of injury or pneumonia, with paediatric mortality from unintentional injuries, pneumonia and Covid-19 infection at 0.77, 0.22 and 0.03 respectively per 100 000 childhood population.
A recent study estimated the regular mortality risk for ages 0 to 19 in South Africa as a 1-in-1 000 chance, while the projected Covid-19 mortality risk in the same age group is 1-in-76 000 (0.001%).
Even though there is scant data on the role of comorbidities in children, the department of basic education has already made provision to allow high risk learners to stay at home. In addition, all school staff members with comorbidities have also been allowed to stay at home without any loss of income, to lower the risk of illness.
The major harms of school closure
Basic education is a basic human right in the country’s Constitution, yet the majority of learners would have missed half of the school year by the end of August, depriving them of this right.
Only about 20% of schoolchildren have access to online schooling, according to the department, and it is estimated that only 10% of households have internet access. This situation is disproportionately affecting vulnerable and disadvantaged children.
The knowledge and skills gap between those with access to the internet and those without will only continue to increase and this loss of education will have long-term and far-reaching economic effects. The department has not implemented any meaningful strategies since March to mitigate any of these effects and a significant percentage of learners have not received any educational material.
The emotional and psychological effects on children during and after lockdown is immense. Recent international reviews show that lockdowns, school closures and natural disasters raise levels of substance abuse, depression, domestic violence and child abuse.
Many learners are already under emotional and psychological stress as a result of poverty, malnutrition, crowded living conditions, child abuse, gender-based violence and other violent crime.
School closures increase childcare obligations, especially healthcare and other essential workers. It has been estimated that if mortality rates for Covid-19 increased from 2% to 2.35% as a result of healthcare worker shortages, school closures would result in more deaths than the lives gained because of slower Covid-19 spread.
By reopening the economy while keeping schools closed, many parents and other caregivers have to leave their children at home unattended. Less than a third of children live in households where both parents are present, and almost 42% live in households where the mother is the only parent present. It is estimated that more than two million children aged 0 to 15 years will be left at home unattended, increasing their risks for accidental injury, abuse, fear, anxiety and isolation.
It seems illogical to close all schools in all provinces and districts if community transmission rates vary so significantly. Allowing school communities to monitor and manage their risks based on local transmission would enable more schools to continue with their activities and limit interruptions.
Those school communities which are at risk, either because of high local transmission rates or poor infrastructure, should be identified and supported immediately to mitigate their risks so that they can reopen as soon as possible. Where schools are unable to reopen, the department must ensure that all learners continue to have adequate academic material through the radio, television, cell phone applications and any other means. Educators must be held accountable for providing ongoing academic support and material at all times.
Dr Fiona Kritzinger writes on behalf of the Paediatrician Management Group and the South African Paediatric Association. She is a paediatric pulmonologist at the Christiaan Barnard Memorial Hospital in Cape Town.