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Medisina at Politika by Dr. Rey Pagtakhan  

Back to school with more

understanding, less agonizing

by Dr. Rey Pagtakhan

There is a universal chorus to bring children safely back to school even in the midst of COVID-19, the worst public health crisis in over a century. At the same time, there have been some very strong dissonant voices against mandatory in-person instruction without flexibility. Why the seeming divide of viewpoints?

I have never observed such intensity of deeply held opposing viewpoints about school re-opening from my reading of the mainstream media, position statements of professional pediatric associations, guidelines of the World Health Organization (WHO), the Public Health Agency of Canada (PHAC) and the USA Centers for Prevention and Disease Control (CDC-USA) and of medical and scientific reports about the burden of the pandemic on children.

Considering the full spectrum of the benefits and risks of in-person versus virtual learning options for children could lead to better a understanding and less agonizing.

The importance of in-person schooling on children’s health and wellbeing

Schools are the children’s second home. They provide not only educational instruction and development of social, emotional, language, communication and interpersonal skills, but also necessary services to children and families. School meal programs address nutritional needs. Organized physical activities guard against obesity. And a bundle of all-encompassing health services – physical, social, and psychological – help alleviate health disparities, relieve families of economic and psychological stress, and lessen the risk of conflict while ensuring a well-rounded and healthy child. Indeed, no other setting other than a child’s home offers a greater influence on their wellbeing. Also, schools play a vital role in the economic health of communities by employing teachers and other personnel.

As a corollary, interruption of in-person schooling harms learning, especially at the higher grade levels. Low-income families are disproportionately disadvantaged due to limited or no access to distance learning. Students with disabilities and developmental delays, who often rely on special education services, counselling, and after-school programs, bear an extra burden. Opportunities for facilitated physical activity – the absence of which is a major risk factor for childhood obesity and accompanying medical problems – are lost. Children who live in a home where neglect or abuse occurs, lose their access to trained school professionals for early identification and needed support.

In an open letter, over 1500 members of the United Kingdom’s Royal College of Paediatrics and Child Health have voiced their concern: that continued school closures “risk scarring the life chances of a generation of young people.”

Agonizing dilemma over school re-opening

Why then the public expression of stress and agonizing sentiments on the part of others? Parents, teachers, local school boards and districts, and healthcare providers, have expressed their fear and apprehension, notwithstanding the guidance and recommendations of authorities in support of classroom instruction. There is also a lower infection rate on children, at least in areas with low community transmission. The illness is less severe and the contagion is spread less among children and in the community. It should be cautioned, however, that one large study showed children 10 and older spread the disease just like adults.

Understandable fear and apprehension

Kathi Valeii, a USA-based writer who has championed parenting issues, opined in her August 20 article for CNN News, “Teachers and students shouldn’t be COVID-19 experiments in the fall.”

“Even though I’m grieving my own kids’ isolation and seclusion, no matter what my district chooses to do, my children will continue to learn remotely when school begins…In an ideal world, opening schools is what everyone wants, sure. But this isn’t an ideal world and it certainly won’t be in a few weeks’ time. Considering in-person instruction as cases continue to climb is unfathomable. What kind of equitable, robust online learning systems, community support networks, and childcare options could have been meaningfully coordinated if remote learning weren’t considered a contingency plan?” She concludes: “There are no perfect solutions for parents right now, but there is only one solution for schools: stay closed until the virus is contained or until there is a vaccine.”

On August 14, the Globe and Mail’s report, “‘It’s really stressful’: Why the decision to opt kids in or out of public school this fall is so difficult,” featured Jeffrey Schiffer, a father of two boys in kindergarten and Grade 4, who, with his wife, had agonized whether to send their children back to the public schools where meaningful social distancing would be difficult to maintain, particularly for the younger one who is prone to viral-induced asthma. “It’s a struggle because we’re both strong supporters of the public education system,” he told the newspaper reporter. “It’s really stressful.”

On July 10, teacher and freelance writer Elana Rabinowitz in her opinion piece for CNN News, “I teach public school. I love my students. I don’t want to die,” wrote: “I understand that we are all desperate to go back to normal. But there is no normal anymore... Perhaps the new normal means thinking of teachers in a new light. The parents among you have all had a glimpse these last few months of what our job entails. If you want us to continue doing it, it’s time for you and your elected officials to work with us to ensure that we are as safe and comfortable at school as you hope your children to be…We want to be there for the kids, especially now. But who will be there for us – the educators? The ones who, along with other school staff, are literally being asked to risk our lives so the economy could go back to normal?” She concluded: “The bottom line is that each school within each district will have to come up with what works best for them…What schools need from the top is support, flexibility and money – not control… we need to redesign schools to include the valuable insight that only classroom teachers can provide.”

On July 12, Dr. Stephen Kessler of Arizona, on behalf of 97 practising physicians who are also parents of school age children, wrote an open letter to state Governor Doug Ducey to share their concern. “…the tremendous pressure to return to in-person schooling in August is ill-advised and dangerous given the uncontrolled spread of COVID-19 in our community. Local school leaders, public health experts, educators and parents must be at the center of decisions about how and when to reopen schools, taking into account the spread of COVID-19 in their communities and the capacities of school districts to adopt safety protocols to make in-person learning safe and feasible.”

These are very soul-searching viewpoints. Who would not be in such a dilemma when we consider the continuing toll on human life.

Magnitude of the human toll

Below is a snapshot of selected numbers from Johns Hopkins University as of August 28, 2020:

WORLDWIDE  24,734,448  835,793  7,700,490
USA  5,913,913  181,789  3,613,757
PHILIPPINES   209,544  3,325   71,745
CANADA  127,358  9,108    5,016

School plans for re-opening

Jennifer Couzin-Frankel, Gretchen Vogel, and Meagan Weiland, writing for the journal Science on July 8, “School openings across globe suggest ways to keep coronavirus at bay, despite outbreaks,” discussed half a dozen questions as they looked at re-opening strategies from South Africa to Finland to Israel: How likely are children to catch and transmit the virus? Should children play together? Should kids wear masks? What should schools do when someone tests positive? Do schools spread the virus to the wider community? What lies ahead?

They found two patterns emerged: 1. a combination of keeping student groups small and requiring masks and some social distancing helps keep schools and communities safe, and 2. opening safely is both about the adjustments a school makes and about how much virus is circulating in the community. The latter influences the likelihood that students and staff will bring COVID-19 into their classrooms.

Canada’s back-to-school plans

These patterns of approach have been reflected in Canada’s plans for re-opening schools. The fact that its 10 provincial and three territorial governments are responsible for education from elementary to postsecondary levels – a constitutional feature of Canadian federalism – has helped ensure that decisions have been crafted with great input from local communities, and have not been anot a top-down control from the national government.

Thus, their rules to govern:

  1. Mandatory or advisory use of face masks in common settings and in the classroom
  2. Class size and levels
  3. Learning groups and cohorts
  4. Blend of in-person and distance learning and options for either
  5. Physical distancing
  6. No sharing of supplies
  7. Staggered schedules for class, lunch and recess
  8. Seating in school buses
  9. Attention to hygiene measures
  10. How to handle a positive case

Backup plans in the event of a moderate to widespread transmission of COVID-19, vary among governments, but the flexibility – the willingness to change direction – is a welcome feature and would go a long way to less agonizing. Readers are advised to check for province or territory-specific rules within the their respective jurisdictions.

Let me end with this statement from the Globe and Mail editorial of August 11: “Parents are going to be watching closely.”

Dr. Rey Pagtakhan graduated from the University of the Philippines and trained at St. Louis Children’s Hospital of Washington University School of Medicine and at Winnipeg Children’s Hospital of the University of Manitoba (UM) Faculty of Medicine. He earned a Master of Science in Perinatal Physiology, with his thesis Initiation of Respiration, from the UM Faculty of Graduate Studies and Research. A retired lung specialist, professor of pediatrics, and Fellow of the American College of Chest Physicians, he was a former school trustee, MP, and cabinet minister. In June 2003, he presented on “The Global Threat of Infectious Diseases” at the G-8 Science Ministers/Advisors Meeting held in Berlin.

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