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Covid-19: Delaying school reopening by two weeks would halve risks to children, says iSAGE

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2079 (Published 22 May 2020) Cite this as: BMJ 2020;369:m2079

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Time to go back to school: several good reasons beyond low infection risk

Dear Editor
Jacqui Wise (1) quite correctly build on the evidence of low risk of contagion of Covid-19 infection among children to call for reopening of schools. There are, however, several other good reasons to be considered.

First, as all international agencies have highlighted, prolonged closure yields serious consequences for all children and particularly for those already living in difficult circumstances, such as extreme poverty, disability, or violent environments. UNESCO estimates that at least 177 countries have instituted school closures at national level and several other countries have established closings at regional or local level (2). With over 90% of students worldwide (more than 1.5 billion young people) currently out of the educational context, it is clear that the greatest threats from Covid-19 to children and adolescents are to be found in educational loss, poorer nutrition, increased exposure to intrafamiliar violence, rising incidence of mental health disorders and lack of physical activity rather than in the clinical consequences of Covid-19 infection (3,4). Inequality in education and health will increase dramatically as consequences are inevitably greater for vulnerable children due to social, material and educational poverty, disability and chronic diseases, special educational needs, and lack of access to distance learning technologies. The risk of dangerous habits, such as increasing screen time and unhealthy feeding will also increase.
In Italy. 9,040,000 children and youngsters and over one million children from nursery schools and early childhood education services have been forced out of schools. Among these, 42% live in overcrowded homes, 12% in poverty, 7% in domestic environments at greater risk of abuse.

Second, irrespective of the magnitude of the estimates - scattered across a wide range of variability - of the contribution of school closure to reduced attack rates of the infection, they cannot be simply converted in corresponding risk of increased infection attack rates consequent to school reopening, since schools and preschool services should be not be reopened just as they were before, but following a series of safety requisites regarding teachers, accompanying caregivers, school environment and children themselves (5).

Third, the risk of school reopening should be measured against the risk of uncontrolled child socialization which will occur anyway, particularly when parents go back to work after lockdown and children are left with grandparents, neighbors or simply remain alone.

Finally, schools and school life represent not only a pillar of community development but also an important part of community identity. The Covid-19 pandemia will cause directly and indirectly a dramatic burden of disease and an economic catastrophe for many countries. A sensible, gradual but prompt reopening of preschool and school activities will not only reduce the risk of a dramatic crisis in child rights but also contribute to restore hope in our communities.
The multidimensional adverse consequences for children of the Covid-19 pandemia have been highlighted at global level by international agencies, but they do not seem to be taken in adequate consideration at country level. Based on global knowledge about the features of the Covid-19 infection and on local epidemiological data, guidelines should be prepared for school reopening at country and local level, with a more holistic perspective of families’ and children’s needs.
A different balance must be found between the risk of increasing the number of Covid-19 cases and causing serious prejudice to children's rights.

References

1. Wise J. Covid-19: Delaying school reopening by two weeks would halve risks to children, says iSAGE. BMJ 2020;369:m2079 doi: 10.1136/bmj.m2079

2.UNESCO. COVID-19 impact on education. https://en.unesco.org/covid19/educationresponse. accessed 7 May, 2020

3. Rosenthal DM, Ucci M, Heys M, Hayward A, Lakhanpaul M. Impacts of Covid- 19 on vulnerable children in temporary accommodation in the UK. Lancet Public Health 2020 March 31 https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30080-3/fulltext

4. Green P. Risks to children and young people during Covid-19 pandemic. BMJ 2020;369:m1669 doi: 10.1136/bmj.m1669 (Published 28 April 2020)

5. Tamburlini G, Marchetti F. Covid-19 pandemia: reasons and indications for reopening education services. Medico e Bambino 2020;39(5):301-304; https://www.medicoebambino.com/lib/covid19_10.pdf

Competing interests: No competing interests

29 May 2020
Federico Marchetti
Director, Pediatrician
Tamburlini Giorgio, Centro per la Salute del Bambino, Trieste, Italy
Department of Pediatrics, “Santa Maria delle Croci” Hospital, Ravenna, Italy
“Santa Maria delle Croci” Hospital, viale Randi, Ravenna, Italy