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Back to school in the midst of a Covid-19 pandemic

<div><p><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/COVID%2019%20drill%202%20body.jpg" alt="" style="margin: 5px;"/> </span></p><p><span style="font-family: helvetica;">​The thought of re-opening schools for many parents puts them on the edge of their seats. Some of this anxiety is largely driven by myths despite public health evidence showing that closure of schools has minimal impact in mitigating COVID-19 pandemic. Schools in the country are expected to reopen fully on 4th January 2021. Earlier on in the pandemic, children who largely exhibit minimal or no symptoms of COVID-19 were labelled as “super-spreaders.&quot; This was largely based on transmission patterns of influenza, however school-based transmission of SARS-CoV-2, the virus that causes COVID-19 may be less important in community transmission. Recent data shows that younger children are unlikely to transmit the virus. The American Academy of Paediatrics recently published a review article that provided data that children were not significant drivers of the COVID-19 pandemic. In England, of 30 school outbreaks reported in June, most were among staff members and only 2 from student to student. 
</span></p><p><span style="font-family: helvetica;">Education remains a key social determinant of health and considerations should be put in place during the COVID-19 pandemic to mitigate profound adverse social, developmental and health outcomes associated with school closures including sexual and gender-based violence that have been on the increase in recent months. Several countries have resumed in-person learning and create an opportunity to learn rather than re-invent the wheel. While one may argue and correctly so that the illustrations are from a well-resourced setting, below is a summary of key recommendations to consider when schools re-open in Kenya; 
</span></p><p><span style="font-family: helvetica;"><strong>Prior to school reopening </strong>
The government has provided schools with guidelines to aid in reopening. Prior to this, schools and more so teachers need to understand how to adapt and tailor these protocols to different ages. Use of pictures that are clear and easy to understand will help learners adhere to protocols on hygiene measures, masking and physical distancing. Physical distancing measures including prohibiting activities that will lead to large gatherings, staggering break times, moving classes to temporary spaces or if conducive outdoors are just some of the innovative measures that teachers can employ. Policy makers should plan to protect staff, teachers and learners who are at high risk of developing severe disease either because of age or underlying medical conditions. Finally, schools need to be clear on a response plan and mitigation measures when there is either a suspected or confirmed case in school. 
</span></p><p><strong style="font-family: helvetica;">School reopening process</strong></p><p><span style="font-family: helvetica;">In October 2020, the government begun a phased reopening process for schools. Whereas masking has proven to be one of the most important tools in mitigating the spread of the virus, one needs to consider the age and capacity of students to understand these measures. Younger children in particular are likely to find it difficult adhering to correct masking and physical distancing measures. Schools will need to reinforce “stay at home policies&quot; if a child is unwell. Despite being in a pandemic, it&#39;s worthwhile to note that other respiratory viral illnesses are common among children and therefore a review by a doctor is highly recommended. Schools should ensure they work closely with parents to regularly update them on precautions and measures being implemented to ensure support and collaboration. This is especially important to ensure children are not stigmatized by peers for being sick. Majority of students either use public transport or are facilitated by school buses for their commute to and from school. During transport ensure physical distancing is maintained and where feasible and safe keep windows open to allow for proper ventilation. </span></p><p><strong style="font-family: helvetica;">With schools reopened </strong></p><p><span style="font-family: helvetica;">The government is expected to closely monitor key pandemic indicators and institute a decision model at either national, county or sub-county level for reclosing and reopening schools as needed due to resurgence of community transmission. Teachers and parents are expected to emphasize the use of masks, hand hygiene and physical distancing measures. Information on mitigation measures should be widely available and accessible to all learners in a child friendly language including brail. Share clear, concise and accurate information about COVID-19, normalize messages about fear and anxiety and promote selfcare strategies not only for students and their families but also teachers and other school staff. In the few notable instances of the negative impact of prolonged school closure including sexual and gender-based violence that have been on the rise, teachers will be required to pick up these cases for prompt referral and appropriate interventions. </span></p><p><span style="font-family: helvetica;">Overall, the decision to close, partially close or fully reopen schools should be guided by a risk-based approach, to maximize the educational, well-being and health benefit for students, teachers, staff and the community at large and help prevent further spread / new community outbreaks. 
</span></p><p><span style="font-family: helvetica;"><strong><em>By Dr Douglas Gaitho, Infectious Diseases Fellow at Aga Khan University Hospital Nairob</em></strong><strong>i</strong></span></p></div>

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