We learned on Monday that the Australian Technical Advisory Group on Immunisation (ATAGI) has advised that Aboriginal and Torres Strait Islander children aged 12-15, those who live in remote communities, and those with underlying medical conditions should be prioritised to receive the jab.
With COVID vaccination for kids being such a hot topic, we asked five experts whether we should vaccinate children in Australia against COVID-19.
Four out of five experts said yes
Here are their detailed responses:
If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: email@example.com.
Asha Bowen is co-chair of the Australian and New Zealand Paediatric Infectious Diseases (ANZPID) group of the Australasian Society of Infectious Diseases. She receives research funding from NHMRC.
Catherine Bennett has received NHMRC and MRFF funding, and is an independent expert on the AstraZeneca advisory board.
Julian Savulescu receives funding from the Wellcome Trust. This work was supported by the UKRI/AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1.
Margie Danchin is a member of ATAGI’s working group on vaccine safety, evaluation, monitoring and confidence.
Nicholas Wood holds an NHMRC Career Development Fellowship and Churchill Fellowship.
Delta is more infectious than the Alpha variant, and preliminary data suggest children and adolescents are at greater risk of becoming infected with this variant, and transmitting it.
Is this true? And with Sydney school students set to begin term 3 remotely, what’s the best way to manage school outbreaks?
Let’s take a look at the evidence.
Delta in children and young people
In the United Kingdom, where the Delta variant has been predominating since May, infections are rising fastest among 17-29-year-olds, who are mostly unvaccinated. Infections are also increasing in younger age groups, but at a lower rate.
Overall, increased transmission among children and young people may partly be due to Delta. But also, in countries like the UK, these age groups are most susceptible to infection because older groups have been largely vaccinated.
While we don’t yet have data on the severity of illness in children associated with the Delta variant specifically, we know with COVID generally, kids are much less likely to become very unwell.
Research from the Murdoch Children’s Research Institute found children clear the virus more quickly than adults, which might go some way to explaining this.
In 2020, face-to-face learning wasn’t a significant contributor to community transmission in Victoria. Similarly, during the first wave in New South Wales, transmission rates were low in education settings. Concerns children may bring infections home to vulnerable family members weren’t supported by the evidence.
However, the situation is looking somewhat different now with the emergence of new variants and varying levels of vaccine coverage in different countries.
There does appear to be more transmission in schools. In the week ending June 27 there were outbreaks in 11 nursery schools, 78 primary schools, 112 secondary schools and 18 special needs schools in the UK.
In 2021 in Australia, there have been very few school infections with Delta. In Western Australia, where schools have remained open, an infectious case attended three schools but this didn’t result in any school outbreaks.
During the current NSW outbreak, there have been several schools and early childhood centres with COVID-19 cases, and we have seen one outbreak at a primary school.
Although schools in Australia have largely been spared, transmission rates have been higher than we’ve seen with other variants. Almost all household contacts of cases are becoming infected.
Fortunately, testing, tracing and isolating were very effective in containing the outbreak, even with the Delta variant.
But these recent school outbreaks highlight why it’s so important adults of all ages, especially parents and teachers, get vaccinated.
Should we vaccinate children?
There are benefits of vaccinating children, particularly teenagers. These include direct protection against the disease, but also reducing transmission to vulnerable adults and enabling continued school attendance.
The risks and benefits need to be carefully calculated in a low transmission setting like Australia. In terms of risks, emerging data suggest the mRNA vaccines Pfizer and Moderna are associated with a very small risk of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the heart lining) in young adolescents and adults, particularly males. Although most cases are mild, it can be a serious condition and is being closely monitored.
The United States, Canada, and a few countries in Europe are already vaccinating children over 12. Australia’s drug regulator is currently weighing this up.
For now, we should continue to vaccinate adults in priority groups. We have a long way to go to get the most vulnerable vaccinated first, and are still constrained by vaccine supply.
As we grapple with the benefits and risks for teenagers, it’s also worth asking them if they want to be vaccinated and why. Many have been adversely impacted by the pandemic and are desperate to move on with their lives.
So it’s imperative parents still take their children to be tested if they become unwell, even if the symptoms appear more like the common cold.
Where to from here?
When adults are more widely vaccinated and our borders open, school outbreaks will likely continue to happen. Even in places like Israel, where a high proportion of the population has received two doses, school outbreaks have recently occurred.
Australia needs a clear plan that outlines how best to keep schools open, while preventing transmission and keeping children and teachers safe during any outbreaks.
This should include school staff being prioritised for vaccination.
And until we have high vaccination coverage, there’s evidence that well implemented school-based mitigation measures work to prevent transmission in education settings.
This could include a range of measures, adjusted according to risk, such as keeping non-essential adults off school grounds, mask use in high school students (and possibly primary students too), staggering timetables, reducing class sizes and improving classroom ventilation.
Alison Poulton, University of SydneyIf your child has been diagnosed with attention deficit hyperactivity disorder (ADHD), you might be wondering: what now? And how do I know if medication is warranted?
The answer will depend on circumstances and will change over time. It’s quite OK to leave medication as a last resort — but it can be a very useful last resort.
Here are some questions I typically work through with a parent and child negotiating this issue.
Five key questions for parents and children with ADHD
1. Is this child underachieving academically in relation to their ability?
Was the child bright as a preschooler but struggled at school for reasons unclear (not, for example, due to vision or hearing problems)? Did they cope OK early in school but didn’t achieve at the level expected when schoolwork got harder?
2. Is this child’s behaviour creating unreasonable levels of stress or disruption at school?
For a child with ADHD to complete a task, it must be sufficiently interesting, short or easy. If a child can’t concentrate in class, they get bored. They might talk in class, create distractions or disrupt class. Obviously, careful judgement is needed to differentiate typical child behaviour from problematic behaviour.
3. Is this child’s behaviour creating unreasonable levels of stress or disruption at home?
At home, is the child able to draw, construct with LEGO, do puzzles or play blocks for longish periods of time? Or do they find the sustained effort needed unachievable? Do they then annoy a sibling to make life more interesting, or constantly ask adults to play with them?
If a child is working on homework for half an hour, how much time is spent concentrating? Are they focused for only ten minutes and the remainder is spent guiding them back on track?
Is the parent tearing their hair out with countless reminders and finding every time they check, the child is distracted again?
4. Is there a significant effect on peer relationships?
Children with ADHD don’t always have the patience to wait their turn or concentrate on what peers say. They may come across as bossy; they find it easier to focus on what’s happening in their own mind but more challenging to listen and process what others say. Their peers may eventually find someone else to play with.
5. Is there an impact on self esteem?
Is this a smart child who doesn’t think they’re smart because they struggle to concentrate long enough to get work done? Do they speak negatively about themselves? It’s important to take self esteem seriously.
There are also diagnostic criteria that need to be checked.
Support strategies at home and in class
What other supports could help? Is the child sitting at the front of class? Is the teacher giving written instructions? Do they sit next to a good role model?
Has the parent done parenting classes? Have they tried home strategies rewarding good behaviour, or giving appropriate consequences for problematic behaviour?
Having a chart for the morning routine can be helpful. Many such strategies work nicely on children without ADHD. But children with ADHD often find the effort needed to earn a sticker isn’t worth it and may try to negotiate ever greater rewards.
If you’ve got to the end of that road and the child is still having problems, you might consider medication.
With ADHD, it’s like your brain is running on a half-charged battery. Your concentration keeps flicking off or winding down. Medication makes it more like your brain is running with a fully charged battery.
The active ingredient in medication is usually a stimulant such as dexamphetamine or methylphenidate. You might know it by the brand name Ritalin.
These stimulants wear off quickly — after about four hours. That may help the child get through the school morning; they may need another dose at lunch and perhaps a third dose if they have after-school activities. There are also capsules that release medication more slowly.
The medication is always wearing off and you are back to square one. On the one hand, that’s a nuisance. On the other, it means you can try medication, then stop and you’ll still have the same child you had at the beginning.
You start low and increase gradually until you find a dose that lasts about four hours. The teacher can help with feedback. The dosage may need to be adjusted as the child grows. These decisions are all made with the support of the clinician.
Generally, you get improvement up to a point where no further benefit is seen. If the dosage is too high, a child may seem aggressive, depressed or “zombie-like”. Nobody wants a dosage that is not leading to a better outcome.
What about side effects?
The most significant side effect is appetite suppression, so we monitor weight and height closely. Generally, weight stabilises in the long run.
Rebound hyperactivity as the medication wears off and difficulty sleeping can occur. Sometimes this can be managed by changing the dosage or by not medicating too late in the day.
The decision to give medication is made on a daily basis. If you aren’t happy, you can omit it and see how things go.
This medication improves anyone’s concentration, not just children with ADHD, so it’s also sometimes a drug of abuse (among university students, for example). When used for treating ADHD, the risk of addiction is minimal.
But if you have concentration problems, you have more scope for improvement. A child who is concentrating most of the time cannot experience much improvement.
I always ask the child: does the medication work? How do you know? I might find out from a teenager that their concentration has improved from 20% to 80% or 90% of classtime. A younger child who prefers to feel in control of their behaviour may actually remind the parent when the next dose is due.
Often I hear from parents the child is now keen to get homework done, has more friends and feels happier and more confident.
All parents want their child to feel they’re functioning and fulfilling their potential. Most will achieve this without medication. That’s plan A. Plan B is that they are fulfilling their potential and living a great life, helped by medication.
Doesn’t every child, every person, with ADHD deserve a plan B?
So, what do we now know about how well antidepressants work in children and young people?
Our new Cochrane review, published today, found that on average, antidepressants led to only small improvements in depression symptoms compared with placebo in children and adolescents (ranging in age from six to 18 years old).
Antidepressants shouldn’t be the first port of call
Our findings highlight antidepressants are no panacea for depression in young people. The small improvements might be so small as to not be very noticeable to the individual person. What’s more, we can’t say to any one young person whether antidepressants will definitely improve their symptoms.
But it’s critical to note there are multiple and complex pathways that lead to the distress and demoralisation that are key in depression.
Different people’s responses to antidepressants are therefore quite specific, and young people may experience anything from marked improvement to deterioration.
Another important finding is that antidepressants are associated with an increased risk of suicidal thinking and self-harm.
These are not necessarily new findings, but they represent the best evidence we have so far. They remain a key consideration for GPs and other health professionals who are considering medications for children and young people.
What is new is our findings on how different antidepressants compare with each other. Many current guidelines recommend fluoxetine as the only first-line medication that should be tried. This is commonly sold under the brand name Prozac.
Fluoxetine is what’s called a “selective serotonin reuptake inhibitor” (SSRI). Serotonin is a neurotransmitter in the brain linked to positive emotions. After it’s used by nerve cells, serotonin is reabsorbed, which is known as “reuptake”. These types of antidepressants work by blocking the reuptake of serotonin, therefore increasing its availability to pass messages between nerve cells.
Our review shows three other antidepressants, including sertraline, escitalopram, and duloxetine, had similar effects to fluoxetine. Though, there’s the caveat that all of these led to only small reductions in depression on average.
However, this finding may extend treatment options for young people with depression. For example, one of these antidepressants may suit one person better than another in terms of side-effects experienced, and the time it takes to work or to wash out of the system.
What other options are there?
Against a backdrop of a global pandemic, there’s a risk we may start to consider depression as the “norm”, passing it over as a given or as insignificant.
But as those with depression, and their parents, families and friends know, depression is anything but. It impacts every facet of life and is often accompanied by a fear it may never improve.
Depression varies substantially between people with multiple factors at play, so it’s important a range of support and treatments are available for people.
Antidepressants have been, and will remain, only one of many options for young people with depression. Guidelines continue to highlight that antidepressants should not be the first port of call.
When used, they should be used in combination with evidence-based talking therapy, the most common being cognitive behavioural therapy (CBT), and there must be a commitment to ensure close monitoring of their impact.
There’s a range of ways in which young people can and need to be supported. There’s good evidence for regular physical activity, good nutrition, and adequate sleep. Support from family, schools and the broader community is also important.
A decision to use antidepressants should be on the basis of shared decision-making. This refers to conversations where the risks and benefits of all treatment options are described to the young person, and their family, who are then meaningfully involved in making the decision.
If the decision is made to use an antidepressant, it’s critical to ensure health professionals conduct regular (weekly at first) checks on depression symptoms and adverse effects. This is particularly important in terms of monitoring the emergence of suicidal thinking and self-harm.
Treatment with an antidepressant should be in the context of talking therapy, and a holistic approach to well-being.
Ensuring access to support and treatment and conveying a sense of hope is crucial.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Adequate sleep is key to good health, well-being and proper functioning across all life stages but is especially critical for children. Poor sleep can inhibit rapid growth and development in early childhood.
And it’s not just about sleep duration; the time one goes to bed also plays an important role in the physical, emotional, and cognitive development of children.
A consistent early bedtime is especially important for young children transitioning from biphasic sleep (where children still nap during the day) to monophasic sleep (where sleep happens at night).
Late sleepers don’t always get the recommended amount of sleep but evidence also suggests late bedtime is associated with sleep quality problems and difficulty falling asleep.
All this can add up to concentration, memory, and behaviour issues in children.
An early bedtime is good for physical health, too
One study of low income preschool-aged children found not getting enough sleep was associated with a higher risk of obesity. A review of academic literature on the question found
Poor sleep is increasingly common in children and associations between short sleep duration in early childhood and obesity are consistently found.
It’s worth noting that most of the studies on this question are cross-sectional, which means they look at data from a population at one specific point in time. That has major limitations that make it hard to say poor sleep habits cause the higher obesity risk.
To know more, we need more longitudinal studies that examine change over time.
That said, emerging evidence from longitudinal studies supports the idea an early bedtime may be worth the battle. One longitudinal study found:
Preschool-aged children with early weekday bedtimes were half as likely as children with late bedtimes to be obese as adolescents. Bedtimes are a modifiable routine that may help to prevent obesity.
My own research, published last year with colleagues in the journal Acta Paediatrica, analysed four years of data from 1,250 Aboriginal and Torres Strait Islander children aged five to eight years old.
The results highlight that even after controlling sociodemographic and lifestyle factors, children who had consistently late bedtimes (after 9.30pm) were on average 1.5kg to 2.5kg heavier at follow up three years later than children who go to bed early (at around 7pm).
Nobody can yet say for sure what the exact relationship is between bedtime and obesity risk. Maybe it’s that staying up late provides more opportunities for eating junk food or drinking caffeinated drinks.
Or there could be more complex physiological factors. The body’s internal clock, which regulates sleep, also plays a crucialrole in hormone secretion, glucose metabolism and energy balance.
How late is late?
Sleep habits are shaped by a range of biological and cultural factors. When parents set their child’s bedtime, they’re influenced by cultural norms, lifestyle and what they know about the importance of sleep.
There are clear guidelines for sleep duration for each age group, but the time a child should go to bed isn’t always as clearly defined. For a pre-schooler, I’d recommend a consistent bedtime between 7pm and 8pm to ensure adequate sleep (recognising, of course, that work and caring responsibilities can make this really difficult for some parents).
Develop an early bedtime routine for your child and try to stick to it, even when it’s “not a school night”. Irregular bedtimes disrupt natural body rhythms and, as many parents know from direct experience, can lead to behavioural challenges in children.
Early childhood is a critical time in which the foundations of life-long habits are built. Developing healthy sleep habits can set children on the right path for better future health and well-being.
During the pandemic, children have been separated from family and friends, schools have been closed and there have been limitations on important activities, such as play.
We know a good deal about the physical effects COVID-19 has on children. But the impact on their mental and emotional well-being is less well understood – particularly from the perspective of children themselves.
Our recently published research highlights the importance of listening to children, about what they have to say and the information they want about COVID-19.
We took part in an international study with children from six countries – the UK, Spain, Canada, Sweden, Brazil and Australia.
We recruited children through our professional and social networks, for example sporting groups and community groups.
We asked children aged seven to 12 years about how they accessed information about COVID-19, about their understandings of the virus and why they were asked to stay at home.
The survey was open when the highest level restrictions were in place across Tasmania, where the Australian arm of the study was based. In total, 49 children from Tasmania took part in the survey and 390 children internationally.
There were important differences across the countries when we conducted the survey, including the numbers of reported cases and deaths from COVID-19, as well as government responses and levels of restrictions.
For example, the reported deaths and cases were much higher in countries such as the UK and Brazil compared to Australia and children in Sweden continued to attend school, whereas most children in other countries were learning from home.
There were many similarities across the different countries in the things important to children, what they had to say and what they wanted to know. But there were also differences across countries and between children.
More than half the children said they knew a lot or quite a bit about COVID-19. Their comments included:
It is a stupid virus.
It spreads really quickly.
People play it down and tell me it can’t kill people, but I know people are dying each day.
But they also had questions:
How and where did it start?
What does the coronavirus actually look like?
How does it make you poorly?
Some said they did not want to know any more about the virus:
It is boring.
I don’t want to know about it because it’s killing people and that makes me sad.
Children expressed different emotions about COVID-19. They said they felt “worried”, “scared”, “angry” and “confused”.
Children knew the virus was particularly dangerous for vulnerable people:
It can possibly kill old and unhealthy people.
And they missed their friends and family:
When can we go back to school?
Children obtained information about COVID-19 from different sources, mostly from parents and teachers. Children also sought information from friends, TV shows and the internet, including social media.
Children understood what the community was being asked to do and they had learnt the meanings of new words and terms. So they knew what social distancing meant and that they needed to stay 1.5m apart.
Children also knew key public health messages about washing your hands, not touching your face and needing to stay at home “to save lives”.
Children have had an important role in society’s response to COVID-19. Their significant contributions to limiting the spread of the virus have included being separated from family and friends, and limitations on important activities that are part of their “normal” lives.
However, the impacts on children’s lives and well-being are largely unacknowledged. Their contributions should be acknowledged and they should be thanked for their part.
Children have a right to be provided with information in a form that is appropriate for their safety and well-being. Children need to have the opportunity to ask questions and learn about what COVID-19 means for them with adults they trust, including parents and teachers.
Children have questions about COVID-19. Questions are different for each child and not all children want the same amount of information.
Adults should make the time and space to have conversations with children. They can ask:
what would you like to know?
what would you like to ask?
This approach means children are empowered to identify their needs and concerns, and the information they are provided is relevant and meets their needs.
Andrea Chelkowski, from the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South and University of Tasmania, Hobart, was part of the Australian research team. The lead author of the research mentioned in this article is Lucy Bray, professor in child health literacy, Edge Hill University, UK.
It’s the first study, to my knowledge, that directly compares children and adults with mild COVID.
Children are less likely to become infected, and when they are, they are more likely to be asymptomatic. This is in contrast to other viral and respiratory infections that are more prevalent among young people.
This new research helps explain how kids’ immune systems work when confronted with the coronavirus — and gives us clues as to why they generally seem to fare better than adults.
The researchers studied 48 kids, mostly in primary school, across 28 households during Melbourne’s second wave. All children were exposed to the coronavirus in their households by infected parents.
This study focused on the “innate” immune response in children, which forms the early part of the immune system’s attack on a virus (or bacteria, or other pathogens). The innate immune system plays an important role in viral protection before the body raises antibodies.
The study found there were dynamic changes in kids’ early immune responses, compared with coronavirus-infected adults.
One key innate immune cell that was elevated in children exposed to the virus was a type of white blood cell called “neutrophils”. These cells patrol the body for infections. When they discover a pathogen, they have a unique ability to respond by trapping and killing the invading pathogen (in this case, the coronavirus).
This role may ensure the virus is not able to infect more cells. This potentially decreases the “viral load”, basically the amount of virus in your body.
For some of the kids in the study, the early immune responses kept the viral load so low that they never returned a positive test, despite being tested throughout the study and having been exposed to coronavirus.
One strength of this study is that it was “longitudinal”, meaning it studied families over time, rather than simply at one point in time. The researchers looked at immune responses of the families just after their exposure to the virus, and returned more than 30 days later to see what had changed. This allowed them to identify the key changes induced because of the exposure to the virus.
Kids vs adults
A key question arising from this research is: why did the kids show such strong immune responses, resulting in few or no symptoms, while their parents were very ill?
It’s a difficult question to answer, at least so far. But the key differences in responses are likely to lie in the early responses of the immune system.
There is some previous research that might give some clues.
One theory surrounds the fact that children have less of the receptors called “ACE2” in their respiratory tract. These receptors are the pathway of entry for the virus into our cells. In theory, less ACE2 receptors mean less chance for the virus to break in and infect our cells. Virus’ don’t survive for very long outside a cell. With less ACE2 receptors, it may give more time for the innate immune cells to control the virus as much as it can while waiting for other immune cells to come along and help.
Another possibility relates to “interferons”, which are alert signals released by cells to tell the body there’s a virus around. Researchers think higher levels of interferons during the early phase of an infection are very important for controlling coronavirus. Potentially, interferons may help promote the increased neutrophils that were seen in children, compared with lower numbers observed in adults.
The wide range of symptoms in COVID are intriguing and frustrating at the same time. Conventional wisdom was that kids are more prone to getting sick with respiratory illnesses than adults — just ask any parent! But with COVID it seems to be the opposite.
Often when we think we’ve nailed down a specific mechanism as to how this new virus works and how our bodies respond to it, it turns out such a mechanism is different across different people. We can see this in the huge range of symptoms that different people display — some get a runny nose, others get a cough, and others suffer extreme exhaustion and respiratory distress or develop “long COVID”, in which symptoms drag on for months.
Coronavirus is still keeping immunologists on their toes. Studies like this one help solve some of the puzzle in understanding who’s at most at risk of severe disease and why.
The COVID vaccine rollout has placed the issue of vaccination firmly in the spotlight. A successful rollout will depend on a variety of factors, one of which is vaccine acceptance. One potential hurdle to vaccine acceptance is needle fear.
In a study that surveyed parents and children in Canada, 24% of parents and 63% of children reported a fear of needles. About one in 12 children and adults alike said they didn’t get all the vaccinations they needed because of their phobia.
Needle phobia generally begins from around age five, and can last through to adulthood. It can be a barrier to health-care access and treatment.
So it’s important to establish positive attitudes towards needle procedures, particularly vaccination, early in life.
Although there’s no one specific reason why people develop needle phobia, people who are anxious and fearful of needles can often relate their concerns back to one poorly-managed needle experience as a child. A bad experience may result from feelings of powerlessness due to being under-informed or being “tricked” into a vaccination.
While it’s important to use a respectful approach at all ages, the four-year-old vaccinations present a particularly valuable opportunity for parents to help children feel comfortable with needle procedures.
The guide below offers a strategy to help make vaccination a positive experience for your child. It’s based on what’s called the respectful approach to child-centred health care. This focuses on the parent and health-care provider developing a cooperative relationship with the child, rather than using authority or incentives.
The aim is to help the child feel in control and reduce anxiety around needle procedures.
Expect some resistance. This is normal — there’s no need to argue, just acknowledge your child’s feelings. Let them know adults don’t particularly like getting vaccinations either!
About a week out, mention again that they’ll be having a vaccination, and give some details, such as where they will be going. Another reminder the day before is helpful.
2. Be honest and transparent
It’s important to check if your child has any questions each time you discuss vaccination with them. Answer as honestly as possible. Yes, it will hurt. But not for long — most of the pain will be gone by the time 30 seconds is up, perhaps as long as it takes to run around the house or say the alphabet.
Help children feel like they are actively part of the process by giving choices where possible. For example, can they have a choice of day, or morning or afternoon?
Check with your health-care provider in advance whether children can choose the location of the injection – normally the vaccines are administered on the outside of the thigh, or the upper arm.
In the lead up, the child might like to prod themselves with a toothpick to see the difference between how each site feels. They may also have a preference for the left or right side.
Sometimes it helps to yell out when you feel pain. Kids may find this fun if you give them free rein to call out anything they want (even “rude” words) when the injection goes in. Just let your health-care provider know in advance so they’re not taken by surprise.
4. Avoid bribes and distractions
Offering a bribe can give the child the impression there’s something terrible about the procedure. As the parent, be confident (or pretend to be confident if you have needle fear yourself). Pain-related beliefs and behaviours can be learnt through observing others, and children are very perceptive.
You can always do a fun activity or have a treat afterwards, but make this a surprise at the end rather than a bribe before the vaccination.
Distractions are common, but can leave the child wondering why they were distracted. “What was going on that was so bad I wasn’t allowed to look at it?”, they might wonder. When children feel they have been deceived, this may erode trust.
Some children may like to watch so they know what’s happening — give them the option. Interestingly, in one study, adults who chose to watch the needle being inserted into their arm reported less pain compared with those who chose to look away.
5. Use mindful parenting
Think of vaccinations as an opportunity to be 100% present, one-on-one with your child. Put aside any multitasking for the morning or afternoon of the vaccination. If you can, take the time off work, turn off your phone, and arrange for any other siblings to be looked after.
Observe your child, aim to listen with your full attention, be compassionate and aware of how you and your child are feeling. All of these things can improve the quality of parent–child relationships and are important for helping children through potentially anxious times.
A year ago, in late January 2020, Australia reported its first cases of COVID-19. Since then, we have seen almost 29,000 confirmed cases and 909 deaths.
As cases climbed in Australian cities in 2020, many students did their schoolwork from home. Australia, including Victoria, came out of lockdowns at the end of last year. But due to outbreaks in New South Wales and Queensland over Christmas and New Year, that impacted on Victoria, restrictions remain in some places.
So what now, for the new school year? Is it safe for students to go back to school?
What we learnt in 2020
Australian health officials, paediatricians, and federal and state education departments worked together to understand how SARS-CoV-2 — the virus that causes COVID-19 — is transmitted in Australian schools.
They also kept updating, as more information came to light, what schools can do to provide a safe learning environment for children and staff.
Up to the end of term 3 in New South Wales, 49 student- and 24 staff- cases were linked to schools and early learning centres. Each of these cases, and their contacts, were followed since the pandemic began. Schools had low rates of transmission — with 51 transmission events (38 students, 13 staff) out of 5,793 contacts traced (<1%) — in terms 1, 2, and 3 when COVID-19 safe measures were in place.
Key measures were:
limiting adults in the school and early learning centre grounds
staying home when unwell with cold-like symptoms
getting tested early.
Most schools and early learning centres in NSW reopened after only a few days.
In Victoria, up until the end of August 2020, 1,635 cases were associated with early learning centres and schools. These consisted of 254 staff, 599 students and 753 household members, out of a total of 19,109 cases in Victoria during their second wave.
Two-thirds of infections in early learning centres and schools did not progress to outbreaks (two or more cases) and more than 90% were small outbreaks (fewer than ten cases).
While transmission has been connected with a Victorian school in the media, transmission events often have a more complex basis than just occurring in the classroom. Schools are often located in a multi-generational community and cases in this large school cluster were linked to high community transmission rates rather than infection in the school.
These studies confirm that when SARS-CoV-2 is detected in a student or staff member, it is very unlikely for other students or staff to be infected at school with the processes put in place in 2020 to provide a safe learning environment.
In Western Australia, almost 14,000 asymptomatic staff and students were swabbed at the school in terms 2 and 3. No cases of SARS-CoV-2 were detected, consistent with the absence of community transmission in that state.
But why are other countries closing schools?
Overseas, studies have shown schools can implement health strategies to safely keep schools open and minimise SARS-CoV-2 transmission risks.
In the US, the Centres for Disease Control and Prevention noted that: “trends among children and adolescents aged 0–17 years paralleled those among adults”. However, the organisation also reported:
as of the week beginning December 6, aggregate COVID-19 incidence among the general population in counties where K–12 schools offer in-person education (401.2 per 100,000) was similar to that in counties offering only virtual/online education (418.2 per 100,000).
Other countries have chosen to close schools as a last resort in national lockdowns in the face of extremely high rates of community transmission and daily case numbers, which meant only widespread reductions in population movements could be effective. This is not the case in Australia at the start of term 1, 2021.
It is common for viruses to evolve and there have now been several new variants of concern such as those identified in the UK, South Africa and Brazil which are more transmissible. The potential of such variants entering Australia is uncertain, and so is the risk of transmission in schools.
Reassuringly, if community transmission of such a variant occurs in Australia, we have established experience to monitor, and hopefully halt, its spread.
So, what should Australia do?
Remote learning provides considerable challenges to keep students engaged, reduces the close supervision and support in the classroom, and provides an added disadvantage for children with mental-health conditions, disabilities or special needs.
For parents, it is difficult to work effectively, provide for the family and maintain their well-being when their child is learning from home.
Based on the above evidence, schools are safe to open. But states should adopt mitigation measures — including when to add masks, reduce attendance or close schools — according to a traffic light system from green (standard measures) to red (close schools) based on the degree of community transmission. The Murdoch Children’s Research Institute has recommended this approach for Victoria. Education departments around Australia can consider a similar approach.
It is important schools and early learning centres continue to adhere to their local COVID advice. Parents and guardians should check their contact details are up to date so they can be contacted easily, regularly check what restrictions are in place and, when unwell, get their child tested and stay at home.
In 2020, students and staff rapidly learned to regularly wash their hands, adapt to cleaners in the school throughout the day, socially distance and wear masks when required. These public health interventions, vaccination, and testing and tracing will remain the mainstay for the year ahead in Australia.
Monitoring well-being and building resilience will also be core educational activities in the months ahead.