The first two cases of COVID-19 (the disease caused by SARS-CoV-2, commonly known as the coronavirus) in Ghana were confirmed by our Health Minister, Kwaku Agyemang-Manu, on 12th March, 2020.
In a national address given on 15th March 2020, President Nana Akufo-Addo prohibited all public gatherings including conferences, workshops, funerals, festivals, political rallies and church activities for four weeks, in order to halt the spread of the virus. Schools and universities were also ordered to close with immediate effect until further notice (though an exception was made for those preparing for the BECE and WASSCE examinations).
On 27th March, the President announced that a partial lockdown would be imposed in Accra and Kumasi as from 30th March. People were to remain at home, only emerging to shop for essential goods or to seek medical care, unless they were classed as working in an essential service. Markets remained opened.
It was a historic moment in this country’s history and all of us under lockdown tried to adjust, rather suddenly, to a completely changed way of life. This was a pandemic, a worldwide phenomenon, and we all watched the unfolding of the invasion of nearly every nation of the world by the coronavirus – and the responses of different governments to these unprecedented events.
The reopening of businesses
The lockdown was initially supposed to last for two weeks, but the President extended it for a further week. When the President announced the end of the lockdown on 19th April, Ghana became the first African nation to lift a Coronavirus lockdown.
After three weeks of lockdown, businesses were allowed to begin to reopen, with some important public health measures in place (such as washing of hands before entry into public places, social distancing and the wearing of masks). There were still risks to people meeting together to do business, but the Government had to balance that risk with the risk of ‘no business’ – which meant the loss of jobs and incomes and the real spectre of famine and poverty, with the possible collapse of the economy. Government, I believe rightly so, reopened businesses.
Public gatherings were still prohibited. However, on 11th May, the Government gave hotels bars and restaurants permission to reopen – provided they followed social distancing guidelines. From 5th June, there was an easing of restrictions concerning religious services, burials and weddings. These were now permitted, provided that strict guidelines were adhered to.
Schools still closed
Schools, however, were not reopened along with businesses and, in fact, have remained closed to date. At the time of writing, schools have been closed for the last 19 weeks.
I would like to raise some questions about this disparity in the treatment of businesses and schools and, in so doing, highlight some serious errors in reasoning underlying these policies.
The assumptions behind the closure of schools
The shutdown of schools was ordered two weeks before that of businesses. The thinking was that schools, as places where large numbers of students were congregating in fairly close contact, were potential venues for the spread of COVID-19. It seemed a reasonable decision – and one which many other nations were taking.
At the time, however, not much was known about how the virus was transmitted and very little data was available to inform decisions.
The World Health Organisation declared the COVID-19 outbreak as a pandemic on 11th March. In the nineteen weeks since that time, large pools of data have been collected, which should provide us with a sound basis for better decision-making.
Children and COVID-19
If we want to calculate the impact of the coronavirus on children, we can look at four indices:
? The rate at which children catch COVID-19.
? The effect of the disease on children.
? How easily children transmit the disease.
? Fatality rates in children.
If we google ‘COVID-19 and age’, we will find many studies (conducted in many different nations) which show that children are the least affected by COVID-19 outbreaks.
Let us look at the data in the table below which summarises data provided by New York City Health as of 13th May 2020:
The table shows data relating to over 15,000 COVID-19 deaths in one particular population. Very marked differences emerge between the death rates in different age segments of the population.
Children between the ages of 0-17 account for only 0.06% of the deaths (that is, less than a tenth of 1%). The percentage of deaths rises to 3.9, however, for the 18-44 age group (65 times greater than the percentage for the 0-17 age group).
Among those in the 45-64 age band, the percentage of deaths rises dramatically to 22.4%. This is over 370 times the percentage for children. The percentage is similar (but only slightly higher) in the 65-74 age group (which accounts for 24.9% of the deaths in the whole population). The highest fatality rate is found in the 75 age group (with a percentage of 48.7%) which suggests that the risk of death for members of this age group is more than 800 times that for children.
Another set of pooled data, drawn from four nations (South Korea, Spain, China and Italy) shows the same trends, with COVID-19 impact being minimal in the youngest age groups but increasing dramatically with an increase in age. See the chart below:
Other studies have shown that not only is the risk of death minimal among the younger age groups, but children also have a lower rate of catching the infection.
Using epidemic data from six countries (China, Italy, Japan, Singapore, Canada and South Korea), one study found that individuals under the age of 20 are only half as likely to contract the disease as those over 20.
Furthermore, in the 10-19 age group, only 21% of those who contracted the virus exhibited any symptoms at all – compared to 69% amongst those aged 70 .
Children have also been shown to be more resilient to COVID-19 infections when they do actually get it. The expression of COVID-19 in children is generally mild, with very high rates of recovery. For example, one study which looked at the data for over 2,000 boys and girls (of median age 7) who had contracted the virus, found that over 94% of cases were moderate, mild or completely asymptomatic.
What about children transmitting the disease? The National Institute for Public Health and the Environment in the Netherlands posted this statement on their website:
Worldwide, relatively few children have been reported with COVID-19, the disease caused by the novel coronavirus. Data from the Netherlands also confirms the current understanding: that children play a minor role in the spread of the novel coronavirus. The virus is mainly spread between adults and from adult family members to children. The spread of COVID-19 among children or from children to adults is less common.
The National Centre for Immunisation, Research and Surveillance in Australia, investigated all cases of COVID-19 cases in the schools of New South Wales from March to mid-April 2020. 9 students and 9 staff members were confirmed as having COVID-19. These 18 individuals were in close contact with a total of 863 people (735 students and 128 staff). When these people were followed up, it was found that none of the staff members subsequently contracted COVID-19. Of the 735 student contacts only one child from one primary school and one student from one high school did later develop COVID-19, but it was not clear whether their infections were due to their contact with one of the original infected students or someone else.
Discussion
One of the key elements in the good practice of science is to allow the data to speak to you and one of the things that the data is saying loudly is that children between the ages of 0 and 17 (an age range which covers most of our school-going populations) are at a very minimal risk of dying from COVID-19 compared with older age groups. As noted above, compared to older age groups, those in the 0 to 17 age group are between 65 and 800 times less likely to die because of COVID-19 than older age groups. This is a highly significant difference between children and adult segments of the population.
Had all this data been available at the beginning of the pandemic, the logical decision when considering which segments of the population to close down first should have been to lockdown the older age groups (from 19 years to 75 ). But we didn’t, we closed down the youngest age groups first. I think we got that wrong.
With hindsight, we can see that the decision to close down schools was not based on sound scientific data but was rather a panic move, based on (what has now proved to be) a false assumption – that people of all ages are equally impacted by COVID-19 (in terms of how easily they contract it, it’s effects on the body and how easily they transmit it).
We can understand that such mistakes could be made at the beginning of the pandemic, when the whole world was gripped with fear of COVID-19 and when there was little knowledge about the epidemiology of the disease. Unfortunately, however, we are continuing to perpetuate the same mistakes when it comes to the re-opening of the country.
When it comes to the re-opening of the country, one would have expected, on the basis of the data, that the first institutions to be re-opened would be the schools – since they are peopled by the segment of the population which we have now shown to be the least at risk – both from catching the disease or dying from it.
However, this was not the case. Perplexingly, the opposite occurred: the higher-risk groups in the population – the adults – were given the go-ahead to return to their normal way of life (albeit with some safety measures in place) while the lowest-risk group was required to remain at home.
I believe we have got it wrong again here. The school children should have been allowed to return to school ahead of the adults being allowed to return to their businesses.
Part of the reason for this anomaly is the real and perceived impact of the lockdown on the two realms of life in which these two populations operate.
Adults operate mainly in the business world. When their activities in this realm are curtailed by a lockdown, financial losses occur, leading to hunger and poverty. These effects can be felt immediately and, consequently, everyone is desirous of keeping the stringent measures of a lockdown to the minimum when it comes to the business areas of our national life.
The impact of the closure of schools on schoolchildren, however, though it has serious implications, is not immediately visible in the economic life of the nation and, as a result, we tend to not give as much weight to learning losses as to financial losses.
How serious are the implications of an extended out-of-school time for children? In an article published on the Brookings Institution website Soland et al have tried to predict learning loss by extrapolating data relating to the documented learning loss which occurs when students are out-of-school for other reasons: absenteeism, weather-related school closures (such as Hurricane Katrina in New Orleans) and summer vacation. The authors talk of a ‘COVID slide’ and project that students in grades 3 to 8 with no online lessons or home-schooling may start the new academic year having lost up to 30% of the learning they achieved in reading during the previous year and up to 50% of the learning they achieved in mathematics. The losses are greater the younger the children, and students who are already struggling are likely to fall even further behind their peers.
Further, the authors point to possible emotional/psychological impacts:
Finally, the effects of COVID-19 our study cannot examine may be the ones most worthy of addressing. Prior research on students displaced by Hurricane Katrina indicated that they had difficulty concentrating and often manifested symptoms of depression in the months following the hurricane.
The longer children are out of school, the greater the impact – educationally and emotionally. Some of the effects of the extended out-of-school time that we are allowing may become manifest only in several years’ time – when it might be too late to correct. And we must remember that any damages to the learning process now will be shown in the economic arena in ten years’ time – to our detriment.
We need to take learning losses as seriously as we take economic losses. If we have been willing to take the much higher risks associated with the re-opening of the economy (an arena dominated by adults), it should be much easier to contemplate the far lower risks posed by the re-opening of schools. Based on the data, the re-opening of schools should have occurred way before the re-opening of the adult-dominated arenas of our national life.
Conclusions
1. Schools should re-open now, since the predominant age group represented in the schools is the least at-risk segment of our population. The closure of the schools was not supported by sound scientific evidence and we should correct this anomaly now.
2. If we have re-opened the country for business, then we should re-open schools, since the risk posed by re-opening businesses far exceeds the risk posed by re-opening schools.
3. The idea that children will catch COVID-19 a in school and take it back home to their parents is not supported by the evidence. Adults are more likely to transmit the virus to their children than vice versa. Children should not be made to bear the brunt of a disease which has been shown, overwhelmingly, to be more at home in adults than in children.
4. Teachers and other adult members of staff, based on the data we now have, are safer in the presence of school children than they are in the presence of the adults in the many other public places (such as markets, shops, restaurants etc) that they can and do freely visit now.
5. Schools, as a whole, are characterized by an atmosphere of discipline and orderliness. Compared to many other environments, therefore, they are much more likely to be able to implement and uphold safety measures and protocols – which will further minimize the risks of transmission of COVID-19, if it does enter the school population.
How should we go about reopening schools?
1. Firstly, we need to correct some wrong impressions
Schools are NOT danger zones for the spread of COVID 19 infections. The fact that schools were the first to be closed down has created the unfortunate impression that, somehow, the coronavirus lives in school campuses! This is not true. The virus lives in people and schools were closed down because they are places where lots of people gather. But, as we have seen, if the people gathering have a minimal chance of contracting the infection, then their gathering is no longer as risky as other gatherings might be (such as adult gatherings).
2. Safety protocols need to be in place
Government should appoint a special School Re-Opening Team that will work with credible and accurate data to provide both guidelines and the resources necessary for basic safety protocols to be implemented in schools. The safety protocols that are recommended for the schools should be based on the scientific data that we have in this country as well as on that from other countries worldwide. The protocols may not have to be exactly the same as those being adopted in fully adult environments.
3. We should start with small steps
To begin with, schools could consider starting with much smaller class sizes to allow them to implement social distancing. Smaller class sizes can be achieved by instituting a rota or shift system so that smaller groups take turns coming into school to use the classrooms. If a school has the capability of providing online learning, then they can offer a blend of online and in-person classes. As schools, students and parents gain confidence in the safety of the school environment, a full in-person timetable can be implemented, with all students present in school.
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Writer: Dr. John Kpikpi
BSc (University of Ghana), D.Phil. (University of Sussex)
City of God Church & New Nation School, Accra
The post Children, education and COVID-19: Why we must reopen schools now [Article] appeared first on Citinewsroom - Comprehensive News in Ghana.
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