Back to school: Safety first

With intensive efforts to mitigate learning losses, the Government of Sri Lanka decided on re-opening schools for in-person learning from 21 October and is in the process of taking swift steps towards full resumption of schools across the country. Ensuring that all measures are taken for safe return is critical at this juncture to guarantee the safety of students and the teachers.  Global evidence is quite promisingly showing that schools do not play a significant role in spreading the virus in the community and Covid-19 does not pose a high risk to children. Also, the evidence is growing to show that teachers are at a lower risk of infection in the school setting, compared to the general adult population.  Following are excerpts from a discussion with Prof. Indika Karunathilake, Professor in Medical Education, Faculty of Medicine, University of Colombo and the Secretary General of Asia Pacific Academic Consortium for Public Health (APACPH) about ensuring the safety in the school premises to assure that the schools are not contributing to spread of the virus.  Ensuring infrastructure facilities  Ensuring the provision of infrastructure facilities adequate for the number of students in the schools is a mandatory fact to consider when re-opening schools. Providing adequate washing stands with continuous water supply and facilities for hand washing at the entrance to the school is one of the basic facility that is essential. Measures for cleaning the toilets regularly and the continuous supply of adequate sanitary liquids, soap or liquid soap is necessary to ensure a safe environment in school. Having at least one Personal Protective Equipment (PPE) kit in each school will be helpful in case of providing care for a suspected infected student or staff member. Prior to starting the schools, organising awareness programs by the medical authorities of the area to educate teachers and nonacademic staff as to how they should work under the Covid-19 pandemic situations would be highly important in conveying the correct messages and debunking the myths. “We should never underestimate the prevailing situation of dengue spread. Therefore, cleaning water drains and gullies and removing mosquito breeding places in school premises is essential to prevent the spread of dengue,” said Prof. Karunathilake, emphasising the threat of a double whammy. Assuring a healthy school premises  In this situation, wearing facemasks at all times should be made compulsory for all children and staff. Supervision of children on adhering to health measures will be necessary at least during the initial period until they adapt with the habits. Checking the body temperature of all students and staff at the entrance of the school may help to find febrile patients. However, we should bear in mind that the majority of patients will not have fever as most children do not show any symptoms. Especially in the schools having larger numbers of students, using additional entrance and exit gates will prevent gathering during school opening and closing times. Restricting the entering outsiders into the school premises during school hours is mandatory and a visitor’s register should be maintained with all the details including the reason for entering the school. Schools where there are hostels, should take all measures to make sure to prevent the hostels becoming super-spreader hotspots.  Schools that provide food for the students may continue to do so under the recommendation of the area Medical Officer of Health (MOH). It is vital to ensure the safety of food provided in the canteens and in the school nutrition programme. Monitoring of food suppliers is necessary at this crucial time.  Safety inside the classrooms  Adhering to basic health guidelines is the strategy in ensuring classroom safety.  Maintain the physical distance and avoid overcrowding: Always maintain a physical distance of at least one metre from others to avoid overcrowding. In order to ensure this, the number of students in a classroom should be restricted to a maximum of 15 students. The classes with the number of students exceeding 15 may divide the students into groups and conduct classes for the groups in alternative weeks or every other day.  Keep hands and environment clean and safe: Washing hands frequently with soap and water for at least 20 seconds or using a hand sanitiser with at least 70% alcohol, avoid touching eyes, nose, and mouth, regularly disinfect frequently touched surfaces are necessary to maintain a safe environment.  Wearing a face mask correctly: Educating the students on how to wear a face mask properly to make sure it covers both the nose and mouth at all times , the correct method of putting on, taking off, and storing of the masks are necessary basic facts to ensure classroom safety.  To facilitate this process, the common spaces of the school such as the main hall should also be used for teaching and learning as it can accommodate more students as per health guidelines. All classrooms should be arranged to have adequate ventilation and whenever feasible learning activities can be conducted outdoors. Seating arrangements of the classrooms should be set to prevent sitting face to face. Advise the parents to keep children at home when having fever, cough, and/or sore throat to prevent the spread of infection into the classroom premises.  School interval  This is the most important time for monitoring health measures as students have to remove their masks to eat food. All students should not be given the interval at the same time. Teachers should supervise younger children and should always prevent exchange of food among each other. Teachers have to encourage students to bring their food from home and discourage consumption of outside food. Students should be advised to wear a new facemask after having food, in order to prevent wearing contaminated masks and to prevent accidental mixing up of masks.  Playing during the interval with friends is one of the most pleasurable activities in school life. Playing outdoors while maintaining the distance should be encouraged to ensure proper physical and mental wellbeing of the students. Facemasks may be removed during outdoor activities.  Sports and extracurricular activities  Sports and extracurricular activities are essential in personality development of children. Outdoor sports such as cricket, volleyball, netball and basketball can be encouraged to commence in schools, adhering to appropriate and feasible health measures. Playing music instruments and dancing classes can be conducted while ensuring distancing. Singing and choir practices also can be done in well ventilated spacious rooms while maintaining a safe distance. “There were some worries regarding the spreading of Covid-19 in swimming pools. It is completely a myth as there is no scientific evidence to prove that Covid-19 virus can survive in swimming pools,” explained Prof. Karunathilake.  Travelling to the school  If the students are residing nearby, it is always safer to walk to the school or ride a bicycle. The public transport, school buses and school vans should limit the number of students transporting at a time. Students should be advised to sit in the relevant seat and avoid moving about unnecessarily inside the vehicle, cleaning hands with sanitiser when getting in and off the vehicle and avoid touching nose and eyes. School vans should not use air conditioners in the vehicles and keeping all shutters opened is necessary to provide proper ventilation.  Covid-19 vaccination  With the efforts of the preventive healthcare system, vaccination of school teachers is almost completed and vaccination of students is currently underway. However, there are many myths looming about vaccination leading to vaccine hesitancy. One of the main misconceptions was about the safety of the vaccine stating that, “the World Health Organisation (WHO) has given only an approval for emergency use as they are only partially tested”. Prof. Karunathilake explained its reality, “During a pandemic, it is a standard procedure to approve vaccines with the emergency use authorisation. There is no compromise in safety standards. WHO and other international health authorities have taken this decision after a careful analysis of risks and the benefits. It is clearly evident that the vaccines have immensely contributed to curtail the number of Covid-19 deaths and hospitalisations. Hence, it is important to believe in evidence-based science and obtain the vaccine. Any medicine carries its side-effects and so is the Covid-19 vaccine. However, the children aged less than 18 years have to get only a single dose and that will significantly reduce the chances of developing side-effects”.  It is important to obtain the vaccine when you get the chance, since it is well proven scientifically that vaccines are the key to minimise severe infection and death.  Responsibility of parents  It is the responsibility of parents to help to keep the school a safe zone. Please refrain from sending your child to school in following situations; 

• If your child is having cough, cold or fever 
• If members of family are in quarantine 
• If a member of a family has been subjected to a PCR test or Rapid Antigen Test, do not send the child to school until receiving the report 
• If your residential area is isolated or locked down due to localised spread of the infection 

Home is the best place to teach basic health instructions to your child. Parents should assist in cleaning the uniforms properly and wash the hands of children when returning from school as it is important to ensure the safety of the household as well.  “We have a window of opportunity to re-start school education. The education of school children was severely affected due to the closure of schools. Therefore, it is the responsibility of all of us to ensure that the conditions favorable for uninterrupted school education are maintained. We need to emphasise this message during the current situation since the number of positive patients including school children is gradually increasing and the possibility of another surge during December-January cannot be ruled out,” Prof. Karunathilake concluded.  (The writer is a Medical Officer at the Directorate of Healthcare Quality and Safety of the Ministry of Health)