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Posts Tagged ‘H1N1 Flu Outbreak’

The global footprint of coronavirus – COVID-19 – is expanding and national governments as well as regional school districts are making the difficult decision to shutdown the schools. On March 11, 2020, the World Health Organization officially declared it a “pandemic” and all of Canada’s education ministers participated in a teleconference to discuss the situation and potential policy responses, specifically following the annual March break for students and teachers.

Political leaders at the highest levels, working closely with public health authorities, are weighing their emergency measures options to combat the pandemic, ranging from school closures to mass quarantines. Closing schools may be politically expedient, but its effectiveness in curbing transmission is far from clear.

School closures have already interrupted the public education of some 300 million students across the globe. The first nation to close schools was Hong Kong, back in January, then Japan on February 27, and now many more jurisdictions have followed suit, including Italy, South Korea, Iran, France, Pakistan, New Delhi, the New York City region and northern Washington State.

Deciding to close schools in the case of COVID-19 is particularly challenging for one major reason. In the initial wave, the novel coronavirus, unlike HIN1 in 2009, had not affected children at high rates. Out of 44,672 initial confirmed cases in China, fewer than 2 per cent occurred in children under 19 years of age, and no deaths were recorded among those younger than 10 years old. That may be a low estimate because the attack rate for children, at a later stage in Shenzhen, was 13 per cent.

Closing schools, in some previous epidemics, has proven helpful in reducing transmission of seasonal flu among children. One 2013 British Medical Journal report, based upon a systematic review of epidemiological studies, concluded that school closures contained rates of transmission, even in the absence of other intentions. Yet determining “the optimal school closure strategy” remained “unclear” because of the wide variation in its forms of implementation.

Tracking the impact of school closures has proven tricky for researchers.  Some closures were limited to individual schools and, in other cases, whole school systems. Closing before the peak of the outbreak or well into the outbreak suggests that decisions are being made as either a precaution or a reaction to rising student influenza-related absenteeism. In some cases, schools close so children can receive antiviral medicines or vaccines, or in conjunction with a strategy of “social distancing.”  Such wide variations in implementation strategies makes it a challenge in determining which change actually affected transmission.

The body of research on school closure impacts during epidemics is surprisingly large, encompassing the 1918 Spanish flu epidemic, the 2002-03 SARS pandemic, and the 2009 HINI flu outbreak.

Yet the results of those school closures have been mixed. Closing schools for more than two weeks has been linked to lower transmission rates in Hong Kong (seasonal and pandemic flus) and in England (H1N1), but not so in Peru (pandemic) or the United States (during seasonal flu epidemics).

The 2008 Hong Kong outbreak, the 1957 epidemic experience of France, and the 1918 pandemic records in some U.S. cities demonstrate that shutting schools can have no discernible impact, especially if decisions come too late in the cycle of the outbreak. Relying upon older parents or grandparents to be caregivers during closures may actually increase mortality rates among more susceptible populations.

Public heath experts caution educational leaders and school principals against basing decisions on the North American H1N1 experience. “The sensitivity of the 2009 pandemic to school closures probably relates to the high attack rates in children compared with adults,” the BMJ study pointed out. “Outbreaks in which children are less affected” such as COVID-19, “might be less sensitive to school closure.”

Closing schools also has broader socio-economic impacts and unrecognized health effects. There are trade-offs in being overly cautious by closing schools, including potential lengthy disruptions in student learning and compelling parents to stay home from work. Students from lower socio-economic neighbourhoods would also be deprived of school meal programs and cost-free supervised athletics activities.

The most authoritative study of school closure impacts, in the August 2009 issue of The Lancet, actually assesses broader community impacts. If all U.K. schools closed, some 30 per cent of health and social care workers would be taken out of commission, compounding adverse effects on the financial health and viability of communities.

School authorities would be well-advised to consider the potential duration of closures in their emergency response plans.  While it is probably wise to err on the side of caution with school-age children, the longer the closure lasts, the more problematic it becomes, especially in the absence of e-learning bridge programs.

Closing schools for more than two weeks to combat COVID-19, as in the case of Hong Kong, could have a detrimental effect upon the school schedule, year-end-examinations, and the conventional grade- promotion system. It’s possible, perhaps likely, that students will be seriously set back by missing so much instructional time.

Implementing “e-learning plans,” including digital and distance learning, is recommended by the U.S. Center for Disease Control and Prevention (CDC), but there’s a major problem with that constructive proposal in its guide for school administrators. It’s feasible in e-learning ready school systems like those in Hong Kong, United Arab Emirates, and the State of Ohio, but not yet in our provincial school systems.

Few Canadian school districts are prepared or trained to implement e-learning days system-wide, and they have, with few exceptions, resisted piloting e-leaning modules during winter season storm days.  Scrambling to implement hastily prepared distance learning or online courses will not prove effective at all. Nor are schools fully equipped to administer year-end assessments online or to report the results electronically to students and parents.

Closing schools may be expedient in assuring the concerned public that actions are being taken to control the spread of the contagion. This is especially so now that managing the fears and anxieties of children and families is emerging as a priority during the COVID-19 pandemic.

Given the lower attack rates for children and the weight of research evidence, it’s much harder to make the call to dismiss classes and suspend school for what may well be an indeterminate period of time.

 Should schools be closed to contain and reduce the transmission of the 2019-20 coronavirus?  What does past experience closing schools during epidemics tell us?  Should schools be closed early in the cycle as a precaution or in reaction to escalating attack rates among children and their teachers? How prepared are school districts to implement e-learning as a bridge in the teaching-learning process?  If schools do close, the question is — for how long given the unpredictability of the spreading contagion?  

*An earlier version of this commentary appeared in The National Post, March 11, 2020. 

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