From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen

Posted on September 7, 2021 by particularkev

C Raina MacIntyre, UNSW; Greg Kelly, The University of Queensland; Holly Seale, UNSW, and Richard Holden, UNSWLast week the New South Wales government announced schools are scheduled to re-open in October. While face-to-face learning undoubtedly has benefits for both children and parents, the announcement left unanswered a series of important questions about how this can be done safely.

By the time NSW lifts restrictions (estimated to be around October), only 60-70% of the population in NSW — and possibly less in Australia — who are 16 years and over may be fully vaccinated.

The Australian Technical Advisory Group on Immunisation (ATAGI) has recommended vaccination for children 12 and over, but most of these children will not be fully vaccinated by October, and children under 12 will remain unvaccinated for now.

In NSW, with well over 1,000 cases a day and rising, there will still be substantial community transmission when schools open. It is unclear when schools in Victoria (where cases are also on the rise) will open, but there may still be some transmission in the state when they do.

So, what do we need to do to make sure kids are as safe as possible at school?

1. Vaccinate the adults around them

In California, a primary school outbreak occurred when an unvaccinated teacher, who came to work despite symptoms, read to students with their mask off. Most kids who became infected were well over 2 metres from the teacher, which confirms the 1-2m distancing rule is not effective for an airborne virus.

Every child and teacher in a classroom or childcare centre with an infected person is at risk. Shared air is the major way SARS-CoV-2 — the virus that causes COVID-19 — spreads.

Children often get the virus from the adults around them, so vaccinating adults in a child’s household, and teachers, can help protect them.

Vaccination is now mandatory for teachers in NSW, but around 67% have had one dose. This probably corresponds to less than 40% of the NSW population being fully vaccinated.

Teacher reading books to kids sitting on the floor. — Anyone in the same room with an infected person, especially if that person isn’t wearing a mask, is at risk of catching the virus.
Shutterstock

One dose of vaccination gives about 31% protection and two doses gives 67% (AstraZeneca) to 88% (Pfizer) protection against the Delta variant. Most kids will still be unvaccinated if schools in the two largest states re-open for the last term of the year. This means it’s even more important to ensure the adults are vaccinated.

2. Mandate masks for teachers and students

We can mandate masks in schools for teachers and students, and highly recommend mask use for younger children in childcare.

The American Academy of Pediatrics recommends masks for children two years and up; children over this age can wear masks without much trouble.

As mask use in schools has been more common overseas, there are now numerous toolkits (including translated versions) and recommendations to support children to wear a mask. For example, your child is more likely wear a mask if it has their favourite colour, sports team, character or special interest on it.

Importantly, a DIY cloth mask can be made to fit your child’s face and be high quality if key design principles are followed. It is important to ensure children have choices and understand the reason why they are wearing a mask (for instance: “When we wear a mask, the virus can’t jump from person to person.”

3. Ventilated classrooms

Classrooms can be ventilated by opening windows (ideally two windows at opposite ends of the room). If there is only one window, a fan can help move the dirty air out. If opening windows is not possible there is fortunately a cheap fix available — portable air purifiers, which dramatically reduce the viral load in classrooms.

There are DIY methods for making air purifiers, too.

4. Reduce numbers of people indoors

Reducing the number of people packed together in a classroom can reduce the risk of COVID. For example, during high epidemic periods, if the decision is made to open schools, a group of kids can come in every second day and learn online on alternate days.

We have shown this approach, when combined with masks, reduces the risk of transmission on university campus.

Use of outdoor spaces for lessons is also a smart move as the weather gets warmer. While Delta can transmit outdoors, the risk is likely much lower.

5. Test school kids

Finally, rapid point-of-care testing in schools will help reduce transmission, and self-testing kits (when approved in Australia) can help.

Saliva tests are also a practical way to test children. These tests are now available in official health settings, so governments could make them available to schools.

What about childcare centres?

We also need to consider childcare centres. Contrary to popular narrative, a new study shows kids up to three years old transmit more than older kids. So, vaccinating childcare workers and parents of young kids is also essential.

All the measures above, except masks for 0-2 year olds, can easily be used in childcare settings.

Girls getting swabbed in the mouth. — Rapid testing in schools could help reduce transmission.
Shutterstock

Record numbers of children are being hospitalised with COVID-19 in the USA. It remains unclear whether the high numbers of sick children are due mostly to Delta’s increased transmissibility, or whether it also causes more severe disease in children, as it does in adults. Although the risk of severe disease remains much lower in children than adults.

One thing we do know is that as vaccination rates increase in adults, unvaccinated groups, the largest of which is children, will be proportionally more at risk. The 70-80% targets for vaccination of eligible adults for relaxing restrictions corresponds to 56-64% of the whole population, which leaves plenty of room for Delta to spread like wildfire in unvaccinated adults and kids. So there is good reason to protect kids if we open schools.

In addition, the productivity losses from lockdowns are an important component of the estimated A$220 million daily economic cost in NSW alone. Sick kids make it harder for their parents to work productively, if at all. And they make it more likely parents themselves become sick and are unable to work.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Greg Kelly, Senior lecturer, The University of Queensland; Holly Seale, Associate professor, UNSW, and Richard Holden, Professor of Economics, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Poorly ventilated schools are a super-spreader event waiting to happen. It may be as simple as opening windows

Posted on August 22, 2021 by particularkev

Geoff Hanmer, University of Technology Sydney and Bruce Milthorpe, University of Technology SydneyInfections of the Deltra strain are increasing across Australia. A significant number of recent outbreaks have been in schools.

In the earlier waves of the COVID outbreak, in 2020, evidence showed children were getting COVID at much lower rates than adults, and the advice from experts was to keep schools open. But a series of papers later showed children were at similar risk of infection to adults.

This is even worse with Delta. According to the US Centers for Disease Control, the Delta variant is about twice as infectious as the earlier strains. And preliminary data suggest children and adolescents are at greater risk of becoming infected with this variant, and transmitting it.

The World Health Organization has recognised SARS-CoV-2, the virus that causes COVID-19, is airborne. The evidence for aerosol transmission is now enough for the Australian Infection Control Expert Group (ICEG), which advises the federal government, to have recently amended its earlier advice that COVID-19 was only spread by contact and droplets:

ICEG has also recognised broader circumstances in which there may be potential for aerosol transmission […] ICEG […] notes the risk may be higher under certain conditions, such as poorly ventilated indoor crowded environments.

“Poorly ventilated indoor crowded environments” accurately describes conditions at many schools. Even in lockdown, schools are still open for children of essential workers and classrooms in use can have relatively high occupancy.

In or out of lockdown, poorly ventilated schools are a super-spreader event waiting to happen.

How are schools ventilated?

Most schools are naturally ventilated. This means windows must be open to deliver fresh air which will dilute and disperse airborne pathogens.

It is not a coincidence the current Australian outbreaks are happening in winter, when naturally ventilated buildings, including most schools, are more likely to have their windows shut to keep the heat in.

Some schools, particularly those with open learning spaces, have buildings too deep for natural ventilation and are mechanically ventilated. This may involve air conditioning, but not all air conditioning includes ventilation. For instance, a split system air conditioner typically recirculates air inside a space whereas ventilation introduces fresh air into the building.

Mechanically ventilated buildings are supposed to have around 10 litres per second (l/s) of fresh air per person. But the temptation to throttle back fresh air to save energy and money is ever present. And even with 10 l/s per person coming in, there may be places with poor ventilation. This includes stairwells, lifts, corridors and assembly spaces.

As aerosols may persist in the air for hours, schools with poor ventilation become a high risk for transmission and kids can take it back to their families.

We have been measuring ventilation in schools and other buildings in Sydney, Canberra, Brisbane and Adelaide using a carbon dioxide (CO2) meter. This is because C02, which is exhaled by humans, is a good proxy for the level of ventilation in a space.

Outside air is about 400-415 ppm (parts per million) of CO2 and well-ventilated indoor environments are typically below 800 ppm with best practice around 600 ppm.

CO₂ monitor in school showing 417ppm — This measurement of a classroom in an older-built school shows safe CO2 levels.
Author provided

Our informal measurements show many newer mechanically ventilated buildings are not well ventilated. Perhaps counter-intuitively, older style naturally ventilated school buildings with leaky wooden windows on both sides of the room and high ceilings often appear to perform well.

Just looking at a building is not a reliable guide to how well ventilated it is.

What schools need to do

We can do several things to ensure schools are well ventilated. The first is to ensure the school has access to a CO2 meter and takes action where CO2 is above 800 ppm.

If the building has windows and doors, open them. This may require kids and teachers putting on an extra layer of clothing, turning up the heating, providing supplementary heaters and making revised security arrangements.

Anything required to keep people safe and thermally comfortable in a well ventilated space is likely to be much cheaper than dealing with an outbreak.

Serviceable standalone NDIR sensor-type CO2 meters can be bought online for less than A$100. More sophisticated networkable devices are available for under A$500.

If the space is mechanically ventilated, a school will need to get a mechanical engineer to work out how the system can be improved. In the meantime, staff could try opening doors, using fans to mix air in large volume spaces or move activities outside.

Where improvements in ventilation are not immediately possible, portable air purifiers can reduce the amount of virus in the air. An air purifier will need at least a HEPA (high-efficiency particulate absorbing) filter to be effective and has to be matched to the size of the room. A typical classroom may need two devices to work and a large open plan space may need several.

In future, we will need to change building regulations to deliver safe, clean air in schools. For now, we just need to do the best we can. It may be as simple as opening the windows.

Geoff Hanmer, Honorary Professional Fellow, University of Technology Sydney and Bruce Milthorpe, Emeritus Professor, Faculty of Science, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Rapid antigen testing isn’t perfect. But it could be a useful part of Australia’s COVID response

Posted on August 1, 2021 by particularkev

Deborah Williamson, The Peter Doherty Institute for Infection and Immunity and Sharon Lewin, The Peter Doherty Institute for Infection and ImmunitySince the start of the pandemic, COVID-19 testing in Australia has been performed using highly sensitive PCR (polymerase chain reaction) tests.

But this conventional model of testing, which involves swabbing by a health-care professional and transporting samples to a laboratory for analysis, has important bottlenecks. Recent reports indicate people have been waiting several hours just to have a swab taken.

With the current COVID outbreaks in Australia, there’s been a renewed focus on alternative testing methods to PCR — in particular rapid antigen testing.

New South Wales this week announced it would begin using rapid antigen tests in schools to allow year 12 students to return to the classroom safely, as well as in essential workplaces.

So what are rapid antigen tests, are they effective, and what role should they play in Australia’s response to COVID-19?

What are antigen tests?

Antigen tests detect protein on the surface of SARS-CoV-2 (the virus that causes COVID-19) directly from a sample taken with a swab inserted into the nose.

Because antigen tests do not amplify parts of the virus’ genetic code, they are less sensitive than PCR tests.

The main advantages of antigen tests over PCR tests include their lower cost and their speed. Most antigen tests are designed to be used at the point of care, with results available in about 15 minutes. They cost roughly A$5 to A$20 per test.

How effective are they?

In countries such as the United Kingdom and United States, antigen tests have been used widely to complement PCR testing during the pandemic.

So far, the strongest published evidence to support the use of antigen tests is in symptomatic people within the first few days of their symptoms starting, when the amount of virus in nasal secretions is highest.

In other words, antigen tests are most accurate when the viral load is highest and when a person is likely to be most infectious. If an antigen test is taken either too early or too late in the course of infection, it may not detect the virus.

There are conflicting data on the performance of antigen tests in people without symptoms. A Cochrane review looking at results across several studies found the sensitivity of antigen tests (the likelihood of a positive result if someone is infected with the virus) was between 40% and 74% in people without symptoms. So a fair proportion of people tested may receive a negative test when they really have the virus.

With this in mind, compared to a “one-off” antigen test, repeated antigen testing (for example, daily) may improve the detection of virus, particularly in people who don’t have symptoms, or when there’s a low level of disease in the community.

Importantly, “real-world” overseas studies looking at antigen testing have varied widely in the types of tests it was compared with, the populations tested, and how much disease was circulating in the community at the time of the study.

This means it’s very hard to extrapolate information from overseas directly to Australia.

We need to trial rapid antigen testing in Australia to get reliable local information

The Therapeutics Goods Administration has so far approved 20 rapid antigen tests for use in Australia.

But antigen tests can only be supplied to accredited laboratories, medical practitioners, health-care professionals working in residential and aged-care facilities, or health departments. The commercial supply of COVID-19 antigen kits for self-testing at home is prohibited.

One way we could properly evaluate the use of antigen tests in Australia is through a series of clinical trials.

These could include trials of returning travellers undertaking daily self-testing in home quarantine, or repeated testing of groups of workers in potentially high-risk workplaces (for example, food distribution centres, construction sites or aged care).

Lessons from HIV

A precedent for community-based self-testing for an infectious disease in Australia is HIV. There were initially concerns the antibody test used for home HIV testing was not sensitive enough, and not as good as the gold standard laboratory test. There were also concerns people wouldn’t know how to deal with a positive test.

But the implementation of HIV self-testing over the past couple of years has been broadly successful. Education campaigns help people understand the limitations of the test, while there are effective processes in place to support people who return a positive result.

Although COVID-19 and HIV are very different diseases, the HIV experience offers useful lessons on how to implement home testing for a high-impact disease in a low-prevalence setting, while ensuring testing is accessible and convenient for all, including marginalised groups.

A woman collects a nasal swab on herself. — Other countries have been using rapid antigen tests as part of their COVID response.
Shutterstock

It’s not perfect, but it could be useful

One fundamental proviso for the use of widespread antigen testing is that we have to be prepared to accept a degree of risk. We know these tests are less sensitive than the current diagnostic “gold standard”, meaning it’s almost certain they will miss some cases of COVID-19.

PCR testing undoubtedly underpins our high-quality laboratory response to COVID-19 in Australia. But our capacity to sustain PCR testing at the level we will eventually need for communities to function normally and for international borders to reopen is uncertain.

We urgently need pragmatic real-world trials of new testing strategies to help us understand how best to return to a “COVID-normal” life.

Deborah Williamson, Professor of Microbiology, The Peter Doherty Institute for Infection and Immunity and Sharon Lewin, Director, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital and Consultant Physician, Department of Infectious Diseases, Alfred Hospital and Monash University, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We need to prioritise teachers and staff for COVID vaccination — and stop closing schools with every lockdown

Posted on June 22, 2021 by particularkev

Asha Bowen, Telethon Kids Institute; Archana Koirala, University of Sydney, and Margie Danchin, Murdoch Children’s Research InstituteYesterday Victoria announced a snap lockdown to last at least seven days starting from 11:59pm last night.

As part of the lockdown, schools will close and move to remote learning, and today is a pupil-free day while schools prepare to teach online. Only the children of authorised workers and vulnerable kids will continue to be able to learn in person.

It’s another episode of schools being closed seemingly as par for the course in any COVID-19 outbreak. While communities are concerned about the outbreak, the inclusion of schools in the lockdown should be as an extension of controls if transmission is more widespread, rather than the immediate response.

Despite good evidence, the previously developed traffic light system isn’t being used for schools during outbreaks in Australia. There’s currently no national plan to guide states and territories on how to manage schools during COVID outbreaks, and to advise them on the evidence and best-practice. This needs to change.

We argue schools should be prioritised to remain open, with transmission mitigation strategies in place, during low levels of community transmission.

What’s more, if schools are a priority, then vaccinating all school staff is something we should be urgently doing as part of these strategies.

Schools should be a priority

As paediatricians and vaccine experts, we believe kids’ well-being and learning should be among the top priorities in any outbreak.

We advocate for strategies to reduce the risk of COVID transmission in schools during outbreaks, including measures like:

minimising parents and other adults on the school grounds, including dropping kids off at the school gate rather than entering the school
parents, teachers, other school staff, and high-school students wearing masks
focusing on hand hygiene
enhanced physical distancing
good ventilation in classrooms and school buildings.

On top of this, we believe if schools, teachers and kids are viewed as a priority by decision makers, then vaccinating all school staff should urgently be considered.

Vaccinating all school staff would reassure those who have concerns about being at work in a school environment during a lockdown, and potentially lower the risk of spread in schools even further. This would increase the confidence in schools remaining open.

Kids are not major drivers of transmission

Kids can and do get sick with the SARS-CoV-2 coronavirus, though they tend to get less severe disease.

The best available evidence suggests kids and schools are not major drivers of transmission, even though children can transmit the virus.

Snap lockdowns have become the new norm in Australia for managing COVID transmission emerging from hotel quarantine. We strongly argue snap lockdowns shouldn’t automatically include schools. Data from overseas, where widespread community transmission is occurring, suggests schools remaining open with public health measures in place hasn’t changed transmission rates very much.

We advocate for schools to remain open, and if a student or teacher attends a school while infectious, the measures in place to test, trace, and isolate the primary and secondary contacts are activated. We have done it before. NSW was able to continue with face-to-face learning and had 88% attendance in term three 2020 even with low levels of community transmission.

When there’s rampant community spread like some countries overseas, this changes the risk-benefit equation and school closures may be needed. The traffic light system has been developed for exactly this scenario.

But with an outbreak of 30 cases so far, we don’t think Victoria is near the flexion point where school closures are necessary. If there were many more, the risk equation would change, and the traffic light system could be applied.

Also, there’s a different risk equation for primary and secondary school students. Primary school kids are much less likely to transmit the virus than secondary school students. Daycare and early childhood centres remain open in Victoria. The evidence supports at least primary schools remaining open too.

We need a national plan on schools

Our concern is that jurisdictions are reaching for school closures as an almost predictable part of lockdown, without relying on a national plan to guide these decisions. The only current guidelines are the Australian Health Protection Principal Committee’s (AHPPC) statement from February on reducing the risk of COVID spread in schools.

Only about 13% of Australians have received at least one COVID vaccine dose, and ongoing community COVID outbreaks are expected for at least the next year or more. So, we need a proper national plan on COVID and schools. States and territories would benefit from a national plan, as they could lean on it to make informed decisions on schools during outbreaks.

School closures cause enormous strain

Whenever school closures are announced, we hear many parents sigh and say things like “I won’t be able to get any work done!”. Indeed, school closures put enormous strain on families, especially working parents with pre-school or primary school aged children. Younger children require some supervision and are less likely to have the skills necessary to get value out of online learning, compared to older kids in the latter stages of high school who may be more independent.

Challenges might also include poor or no internet, not being able to have relevant supervision, or not having the right devices.

Home learning has a substantial impact on children’s well-being and mental health. Over 50% of Victorian parents who participated in a Royal Children’s Hospital poll in August 2020 reported homeschooling had a negative impact on their kids’ emotional well-being during the second wave in 2020. This was compared to 26.7% in other states. Jurisdictions keep playing into this risk if they keep closing schools.

It’s an absolute priority we find and use ways to support kids to continue face-to-face learning in times of low community transmission, especially primary schools. One important way to do this is to prioritise teachers and other school staff for COVID vaccines.

Asha Bowen, Program Head of Vaccines and Infectious Diseases, and Head of Skin Health, Telethon Kids Institute; Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney, and Margie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Children may transmit coronavirus at the same rate as adults: what we now know about schools and COVID-19

Posted on November 26, 2020 by particularkev

Zoë Hyde, University of Western Australia

The role children, and consequently schools, play in the COVID-19 pandemic has been hard to work out, but that puzzle is now finally starting to be solved.

The latest research shows infections in children frequently go undetected, and that children are just as susceptible as adults to infection. Children likely transmit the virus at a similar rate to adults as well.

While children are thankfully much less likely than adults to get seriously ill, the same isn’t true for the adults that care for them. Evidence suggests schools have been a driver of the second wave in Europe and elsewhere. This means the safety of schools needs an urgent rethink.

It’s hard to detect COVID-19 in children

Infections with SARS-CoV-2, the virus that causes COVID-19, in children are generally much more mild than in adults and easy to overlook. A study from South Korea found the majority of children had symptoms mild enough to go unrecognised, and only 9% were diagnosed at the time of symptom onset.

Researchers used an antibody test (which can detect if a person had the virus previously and recovered) to screen a representative sample of nearly 12,000 children from the general population in Germany. They found the majority of cases in children had been missed. In itself, that’s not surprising, because many cases in adults are missed, too.

But what made this study important, was that it showed young and older children were similarly likely to have been infected.

Official testing in Germany had suggested young children were much less likely to be infected than teenagers, but this wasn’t true. Younger children with infections just weren’t getting tested. The study also found nearly half of infected children were asymptomatic. This is about twice what’s typically seen in adults.

But children do transmit the virus

We’ve known for a while that around the same amount of viral genetic material can be found in the nose and throat of both children and adults.

But that doesn’t necessarily mean children will transmit the same way adults do. Because children have a smaller lung capacity and are less likely to have symptoms, they might release less virus into the environment.

However, a new study conducted by the US Centers for Disease Control and Prevention (CDC) found children and adults were similarly likely to transmit the virus to their household contacts.

Another study, of more than 84,000 cases and their close contacts, in India found children and young adults were especially likely to transmit the virus.

Most of the children in these studies likely had symptoms. So, it’s unclear if asymptomatic children transmit the virus in the same way.

But outbreaks in childcare centres have shown transmission by children who don’t show symptoms still occurs. During an outbreak at two childcare centres in Utah, asymptomatic children transmitted the virus to their family members, which resulted in the hospitalisation of one parent.

What we know about outbreaks in Australian schools

Schools didn’t appear to be a major driver of the epidemic in Victoria, although most students switched to remote learning around the peak of the second wave.

However, schools did contribute to community transmission to some extent. This was made clear by the Al-Taqwa College cluster, which was linked to outbreaks in Melbourne’s public housing towers.

When researchers analysed cases in Victorian schools that occurred between the start of the epidemic and the end of August 2020, they found infections in schools mirrored what was happening in the community overall. They also found 66% of all infections in schools were limited to a single person.

A closed-school sign on the gate. — Most students in Victoria switched to remote learning at the peak of the second wave.
Shutterstock

This might seem encouraging, but we have to remember this virus is characterised by superspreading events. We now know that about 10% of infected people are responsible for about 80% of secondary COVID-19 cases.

Two major studies from Hong Kong and India revealed about 70% of people didn’t transmit the virus to anyone. The problem, is the remainder can potentially infect a lot of people.

What happened in Victorian schools was entirely consistent with this.

The risk associated with schools rises with the level of community transmission. The picture internationally has made this clear.

What we know about outbreaks in schools, internationally

After schools reopened in Montreal, Canada, school clusters quickly outnumbered those in workplaces and health-care settings combined. President of the Quebec Association of Infectious Disease Microbiologists, Karl Weiss, said

Schools were the driver to start the second wave in Quebec, although the government did not recognise it.

A report by Israel’s Ministry of Health concluded school reopening played at least some role in accelerating the epidemic there, and that schools may contribute to the spread of the virus unless community transmission is low. In the Czech Republic, a rapid surge in cases following the reopening of schools prompted the mayor of Prague to describe schools as “COVID trading exchanges”.

The opposite pattern has been seen when schools have closed. England just witnessed a drop in new cases, followed by a return to growth, coinciding with the half-term school holidays. This was before any lockdown measures were introduced in the country.

These observations are consistent with a study examining the effect of imposing and lifting different restrictions in 131 countries. Researchers found school closures were associated with a reduction in R — the measure of how fast the virus is spreading — while reopening schools was associated with an increase.

The risk has been spelled out most clearly by the president of the Robert Koch Institute, Germany’s equivalent of the US Centers for Disease Control and Prevention. Last week, he reported the virus is being carried into schools, and also back out into the community.

What we need to do

It won’t be possible to control the pandemic if we don’t fully address transmission by children. This means we need to take a proactive approach to schools.

At a minimum, precautionary measures should include the use of face masks by staff and students (including primary school students). Schools should also improve ventilation and indoor air quality, reduce class sizes, and ensure kids and staff practise hand hygiene.

School closures have a role to play as well. But they must be carefully considered because of the harms associated with them. But these harms are likely outweighed by the harms of an unmitigated epidemic.

In regions with high levels of community transmission, temporary school closures should be considered. While a lockdown without school closures can probably still reduce transmission, it is unlikely to be maximally effective.

Zoë Hyde, Epidemiologist, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How creative use of technology may have helped save schooling during the pandemic

Posted on October 27, 2020 by particularkev

Neil Selwyn, Monash University

It is estimated around half the world’s students’ schools remain shut down. All told, this has been a potentially damaging disruption to the education of a generation.

But one of the few positive outcomes from this experience is an opportunity to rethink how digital technologies can be used to support teaching and learning in schools.

Our collective experiences of remote schooling offer a fleeting opportunity for schools to think more imaginatively about what “digital education” might look like in the future.

This is not to echo the hype (currently being pushed by many education reformers and IT industry actors) that COVID will prove a tipping-point after which schools will be pushed fully into digital education.

On the contrary, the past six months of hastily implemented emergency remote schooling tell us little about how school systems might go fully virtual, or operate on a “blended” (part online, part face-to-face) basis. Any expectations of profiting from the complete digital reform of education is well wide of the mark.

Instead, the most compelling technology-related lessons to take from the pandemic involve the informal, improvised, scrappy digital practices that have helped teachers, students and parents get through school at home.

Technology during the pandemic

All over the world, school shutdowns have seen teachers, students and families get together to achieve great things with relatively simple technologies. This includes the surprising rise of TikTok as a source of informal learning content. Previously the domain of young content creators, remote schooling saw teachers of all ages turn to the video platform to share bite-size (up to one minute) chunks of teaching, give inspirational feedback, set learning challenges or simply show students and parents how they were coping.

TikTok also been used as a place for educational organisations, public figures and celebrity scientists to produce bespoke learning content, as well as allowing teachers to put together materials for a wider audience.

Even principals have used it to keep in contact with their school — making 60-second video addresses, motivational speeches and other alternatives to the traditional school assembly speech.

Classes in some countries have been run through WhatsApp, primarily because this was one platform most students and families had access to, and were used to using in their everyday lives.

Elsewhere, teachers have set up virtual BitMoji classrooms featuring colourful backdrops and cartoon avatars of themselves. These spaces act as a friendly online version of their familiar classroom space for students to check in and find out what they should be learning, access resources and temporarily feel they were back at school.

Some teachers have worked out creative ways of Zoom-based teaching. These stretch beyond the streamed lecture format and include live demonstrations, experiments, and live music and pottery workshops.

Social media, apps and games have proven convenient places for teachers to share insights into their classroom practice, while students can quickly show teachers and classmates what they have been working on.

These informal uses of digital media have played an important role in boosting students, teachers and parents with a bit of human contact, and additional motivation to connect and learn.

So, what now?

All this will come as little surprise to long-term advocates of popular forms of digital media in education. There is a sound evidence base for the educational benefits of such technology.

For example, a decade’s worth of studies has developed a robust framework (and many examples) of how students and educators can make the most of personal digital media inside and outside the classroom. These include allowing students to participate in online fan-fiction writing communities, digital journalism, music production and podcasting.

The past ten years has also seen a rise in e-sports — where teams of young people compete in video games.

This stresses the interplay between digital media, learning driven by students’ interests and passions, and online communities of peers. Informal digital media can be a boon for otherwise marginalised and disadvantaged youth and allowing students to find supportive communities of like-minded peers regardless of their local circumstances.

Australia continues to be one of the few countries in the world where classroom use of smartphones is banned by some governments. Some of the most popular social media platforms, content creation apps, and open sites such as YouTube remain filtered and blocked in many schools too.

At the same time, official forms of school technology are increasingly criticised for being boring, overly-standardised, and largely serving institutional imperatives, rather than pitched toward the interests of students and teachers.

Concerns are growing over the limited educational benefits of personalised learning systems, as well as the data and privacy implications of school platforms and systems such as Google Classroom.

The past six months have seen many schools forced to make the best of whatever technologies were immediately to hand. Previously reticent teachers now have first-hand experience of making use of unfamiliar technologies. Many parents are now on board with the educational potential of social media and games. Most importantly, students have been given a taste of what they can achieve with “their” own technology.

With US schools now exploring the benefits of establishing official TikTok creation clubs to enhance their video-making skills, it might be time for Australian educators to follow suit. Let’s take the opportunity to re-establish schools as places where teachers, students and families can work together to creatively learn with the devices and apps most familiar to their everyday lives.

Neil Selwyn, Distinguished Research Professor, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Behind Victoria’s decision to open primary schools to all students: report shows COVID transmission is rare

Posted on September 28, 2020 by particularkev

Fiona Russell, University of Melbourne; Edward Kim Mulholland, Murdoch Children’s Research Institute; Kathleen Ryan, Murdoch Children’s Research Institute; Kathryn Snow, University of Melbourne; Margie Danchin, Murdoch Children’s Research Institute, and Sharon Goldfeld, Murdoch Children’s Research Institute

At the weekend, Victorian Premier Dan Andrews announced all the state’s primary school kids would return to school for Term 4. This is an update from the previously planned staggered return to primary school, which would begin only with students in the early years — prep (first year) to Year 2.

The change was informed by our analysis of Victorian health and education department data on all cases and contacts linked to outbreaks at schools and early childhood education and care services (childcare and preschool).

We included data between January 25 (the date of the first known case in Victoria) and August 31.

Our analysis found children younger than 13 seem to transmit the virus less than teenagers and adults. In instances where the first case in a school was a child under 13, a subsequent outbreak (two or more cases) was uncommon. This finding played a key role in helping make the decision for primary school children to return to school.

Here is what else we found.

1. Outbreaks in childcare and schools are driven by community transmission

Infections linked to childcare, preschools and schools peaked when community transmission was highest in July, and declined in August. In addition, they were most common in the geographical areas where community transmission was also high.

This suggests infections in childcare, preschools and schools are driven primarily by transmission in the broader community. Controlling community transmission is key to preventing school outbreaks.

2. School infections are much lower than in the community

There were 1,635 infections linked with childcare, preschools and schools out of a total of 19,109 cases in Victoria (between January 25 and August 31).

Of 1 million students enrolled in all Victorian schools, 337 may have acquired the virus through outbreaks at school.

Of 139 staff and 373 students who may have acquired infection through outbreaks at childcare, preschools or schools, eight (four staff and four students) were admitted to hospital, and all recovered.

The infections in childcare, preschools and schools were very rarely linked to infections in the elderly, who are the most vulnerable to COVID-19.

3. Most infections in schools and childcare centres were well contained

Of all the outbreaks in Victorian childcare centres, preschools and schools, 66% involved only a single infection in a staff member or student and did not progress to an outbreak. And 91% involved fewer than ten cases.

Testing, tracing and isolation within 48 hours of a notification is the most important strategy to prevent an outbreak.

The majority of infections in childcare, preschools and schools were well contained with existing controls and rapid closure (within two days), contact tracing and cleaning.

4. Households are the main source of infection, not schools

The investigations of cases identified in schools suggest child-to-child transmission in schools is uncommon, and not the primary cause of infection in children. Household transmission has been consistently found to be the most common source of infection for children.

Closing schools should be a last resort

Based on our findings and a review of the international literature, we recommend prioritising childcare centres, preschools and schools to reopen and stay open to guarantee equitable learning environments — and to lessen the effects of school closures.

Children do transmit the virus and outbreaks can occur. But based on the international literature, this mostly happens when there are high rates of community transmission and a lack of adherence to mitigation measures (such as social distancing) at the school or childcare centre.

Childcare centres, preschools and schools play a critical role not only in providing education, but also offering additional support for vulnerable students.

With childcare centres and schools being closed, along with the additional economic and psychological stress on families, family conflict and violence has increased. This has led to many children and young people feeling unsafe and left behind in their education and suffering mental-health conditions.

Closing all schools as part of large-scale restrictions should be a last resort. This is especially the case for childcare centres, preschools and primary schools, as children in these age groups are less likely to transmit the virus, and be associated with an outbreak.

Now that community transmission in Victoria is so low, it’s time for all kids to go back to school.

The authors would like to thank their advisory committee from the Department of Education and Training and the Department of Health and Human Services. They would also like to thank outbreak epidemiologists at the DHHS and medical students Alastair Weng, Angela Zhu, Anthea Tsatsaronis, Benjamin Watson, Julian Loo Yong Kee, Natalie Commins, Nicholas Wu, Renee Cocks, Timothy O’Hare, and research assistant Kanwal Saleem, and Belle Overmars.

Fiona Russell, Principal research fellow, University of Melbourne; Edward Kim Mulholland, Professor, Murdoch Children’s Research Institute; Kathleen Ryan, Research Fellow, Asia-Pacific Health, Infection and Immunity Theme, Murdoch Children’s Research Institute; Kathryn Snow, Epidemiologist, University of Melbourne; Margie Danchin, Associate Professor, University of Melbourne, Murdoch Children’s Research Institute, and Sharon Goldfeld, Director, Center for Community Child Health Royal Children’s Hospital; Professor, Department of Paediatrics, University of Melbourne; Theme Director Population Health, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Children might play a bigger role in COVID transmission than first thought. Schools must prepare

Posted on August 30, 2020 by particularkev

Zoë Hyde, University of Western Australia

Over the weekend, the World Health Organisation made an announcement you might have missed.

It recommended children aged 12 years and older should wear masks, and that masks should be considered for those aged 6-11 years. The German Society for Virology went further, recommending masks be worn by all children attending school.

This seems at odds with what we assumed about kids and COVID-19 at the start of the pandemic. Indeed, one positive in this pandemic so far has been that children who contract the virus typically experience mild illness. Most children don’t require hospitalisation and very few die from the disease. However, some children can develop a severe inflammatory syndrome similar to Kawasaki disease, although this is thankfully rare.

This generally mild picture has contributed to cases in children being overlooked. But emerging evidence suggests children might play a bigger role in transmission than originally thought. They may be equally as infectious as adults based on the amount of viral genetic material found in swabs, and we have seen large school clusters emerge in Australia and around the world.

How likely are children to be infected?

Working out how susceptible children are has been difficult. Pre-emptive school closures occurred in many countries, removing opportunities for the virus to circulate in younger age groups. Children have also missed out on testing because they typically have mild symptoms. In Australia, testing criteria were initially very restrictive. People had to have a fever or a cough to be tested, which children don’t always have. This hindered our ability to detect cases in children, and created a perception children weren’t commonly infected.

One way to address this issue is through antibody testing, which can detect evidence of past infection. A study of over 60,000 people in Spain found 3.4% of children and teenagers had antibodies to the virus, compared with 4.4% to 6.0% of adults. But Spain’s schools were also closed, which likely reduced children’s exposure.

Another method is to look at what happens to people living in the same household as a known case. The results of these studies are mixed. Some have suggested a lower risk for children, while others have suggested children and adults are at equal risk.

Children might have some protection compared to adults, because they have less of the enzyme which the virus uses to enter the body. So, given the same short exposure, a child might be less likely to be infected than an adult. But prolonged contact probably makes any such advantage moot.

The way in which children and adults interact in the household might explain the differences seen in some studies. This is supported by a new study conducted by the Centers for Disease Control and Prevention. Children and partners of a known case were more likely to be infected than other people living in the same house. This suggests the amount of close, prolonged contact may ultimately be the deciding factor.

How often do children transmit the virus?

Several studies show children and adults have similar amounts of viral RNA in their nose and throat. This suggests children and adults are equally infectious, although it’s possible children transmit the virus slightly less often than adults in practice. Because children are physically smaller and generally have more mild symptoms, they might release less of the virus.

In Italy, researchers looked at what happened to people who’d been in contact with infected children, and found the contacts of children were more likely to be infected than the contacts of adults with the virus.

Teenagers are of course closer to adults, and it’s possible younger children might be less likely to transmit the virus than older children. However, reports of outbreaks in childcare centres and primary schools suggest there’s still some risk.

What have we seen in schools?

Large clusters have been reported in schools around the world, most notably in Israel. There, an outbreak in a high school affected at least 153 students, 25 staff members, and 87 others. Interestingly, that particular outbreak coincided with an extreme heatwave where students were granted an exemption from having to wear face masks, and air conditioning was used continuously.

At first glance, the Australian experience seems to suggest a small role for children in transmission. A study of COVID-19 in educational settings in New South Wales in the first half of the year found limited evidence of transmission, although a large outbreak was noted to have occurred in a childcare centre.

This might seem reassuring, but it’s important to remember the majority of cases in Australia were acquired overseas at the time of the study, and there was limited community transmission. Also, schools switched to distance learning during the study, after which school attendance dropped to 5%. This suggests school safety is dependent on the level of community transmission.

Additionally, we shouldn’t be reassured by examples where children have not transmitted the virus to others. Approximately 80% of secondary COVID-19 cases are generated by only 10% of people. There are also many examples where adults haven’t transmitted the virus.

As community transmission has grown in Victoria, so has the significance of school clusters. The Al-Taqwa College outbreak remains one of Australia’s largest clusters. Importantly, the outbreak there has been linked to other clusters in Melbourne, including a major outbreak in the city’s public housing towers.

Close schools when community transmission is high

This evidence means we need to take a precautionary approach. When community transmission is low, face-to-face teaching is probably low-risk. But schools should switch to distance learning during periods of sustained community transmission. If we fail to address the risk of school outbreaks, they can spread into the wider community.

While most children won’t become severely ill if they contract the virus, the same cannot be said for their adult family members or their teachers. In the US, 40% of teachers have risk factors for severe COVID-19, as do 28.6 million adults living with school-aged children.

Children walk to school with masks — In the US, 40% of teachers have risk factors for severe COVID-19, as do 28.6 million adults living with school-aged children.
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Recent recommendations on mask-wearing by older and younger children mirror risk-reduction guidelines for schools developed by the Harvard T. H. Chan School of Public Health. These guidelines stress the importance of face masks, improving ventilation, and the regular disinfection of shared surfaces.

The changing landscape

As the virus has spread more widely, the demographic profile of cases has changed. The virus is no longer confined to adult travellers and their contacts, and children are now commonly infected. In Germany, the proportion of children in the number of new infections is now consistent with their share of the total population.

While children are thankfully much less likely to experience severe illness than adults, we must consider who children have contact with and how they can contribute to community transmission. Unless we do, we won’t succeed in controlling the pandemic.

Zoë Hyde, Senior Research Officer, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Victoria’s Year 12 students are learning remotely. But they won’t necessarily fall behind

Posted on August 7, 2020 by particularkev

Sarah Prestridge, Griffith University and Donna Pendergast, Griffith University

In early July, Victorian Premier Daniel Andrews announced government school students in prep to Year 10 — in Metropolitan Melbourne and the Mitchell Shire —would learn from home for term three. Students in Years 11 and 12, as well as those in Year 10 attending VCE or VCAL classes, and students with special needs, would learn face to face.

The exemption for students doing VCE subjects to go class was made to ensure the least amount of disruption to the final years of schooling.

From today, however, after the announcement of harsher, Stage 4 restrictions for metropolitan Melbourne and Stage 3 restrictions for the rest of Victoria, students in Years 11 and 12 will learn remotely with every other student in the state.

So, will remote learning at the end of schooling mean Victorian students will fall behind the rest of the country?

Setting up Year 12s for further learning

Year 12 marks the end of school and the shift to work and further education for most students.

The Year 12 journey is sprinkled with milestones and rites of passage: the school formal, leadership opportunities, gaining independence with a new driver’s license and for many, turning 18 and being regarded as an adult.

In classrooms, learning is highly regulated by the teacher. Whereas in vocational education and training, and university, learning is rapidly moving to a more online, independent, mode. Even before the pandemic, post-school education required students to be more self-directed learners than they were at school.

This year’s Year 12 students won’t experience many common milestones and rites of passage. But many will have gained significant experiences of learning online, and independently — beyond what they ordinarily would have — which will set them up for similar learning beyond school.

The chance to develop online learning capabilities while being supported by their school teachers will give Year 12s learning remotely a real advantage.

Year 12s like learning independently

We conducted a survey of students who experienced remote schooling during March and April this year at an independent school in Queensland. Overall 1,032 students completed the survey, across prep to Year 12.

Just over 41% of students, overall, said they found learning at home stressful. But this was generally not the case for students in Year 12. Year 12 students were keen for the flexibility to learn at their own pace, and being free to determine the order of study each week, rather than follow a timetable set by the school.

Younger students find remote learning more stressful than do Year 12s.
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Year 12 students said they preferred to concentrate on one subject a day and to work intensely.

Generally Year 12 students said they disliked live video sessions and found them disruptive to their study flow. While 75% of Grade 7 students valued form class or home room live sessions, only 16% of Grade 12 students did. They preferred to spend their time focusing on given subject materials.

Is online learning inferior to face to face?

Studies have suggested online learning is likely to be less effective than classroom education over the longer-term. But there is also evidence to suggest the impact may be negligible in the short term.

Other studies suggest there is no significant difference in learning outcomes between students in distance education (when students live too far from the school to attend in person) and face-to-face learning.

But there are significant variations in outcomes within each approach. This means a student’s ability to learn online, the design of the online learning environment and even the amount of time needed for students to get familiar with learning online can affect their outcomes.

Students have been conditioned for over 12 years to learn in classrooms from a teacher. This can make it difficult for them to become familiar with new ways of learning.

A major issue associated with online learning is a student’s ability to regulate themselves. This means being able to stay on task especially when a problem arises. Being unfamiliar with new ways of accessing and interpreting online environments and subject content, as well as working with peers online in communication spaces, presents new challenges for students.

However, the problem may again have to do with age. In our survey, mentioned above, 75% Year 12 students believed they were able to work through a problem productively online. This was higher than the other high-school year levels.

Tips for Year 12 students

There are many advantages to learning online. Students can work at their own pace, revise and review teacher made videos for examples, and engage with extensive notes and study guides to help with assessment and exams.

Students can also access their teachers in more varied ways and at different times of day. In other words, moving online for Year 12 students can provide a world of resources and access to teachers they have not experienced before.

To make the most of their Year 12 experience, students should keep these simple tips in mind:

organise your learning week. Set up your own timetable of tasks to complete. Include breaks and time to relax
be an active learner. Make notes while listening to teacher made videos and written materials
contact a friend if you have a problem, and work through the issue together
use the communication tools available to tell your teachers and friends what you are thinking about
participate in live sessions and forums as much as you can.

Correction: this article previously had an incorrect statement about ATAR calculation. This has now been removed.

Sarah Prestridge, Senior Lecturer, Griffith University and Donna Pendergast, Dean, School of Educational and Professional Studies, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Will school temperature checks curb the spread of coronavirus?

Posted on July 26, 2020 by particularkev

Fiona Russell, University of Melbourne and Kathleen Ryan, Murdoch Children’s Research Institute

This week, most students in Melbourne and Mitchell Shire returned to remote learning for term 3.

Students whose parents can’t work from home are allowed to receive remote learning from school, as was the case during the first lockdown.

But this time, students in years 11 and 12, students in year 10 undertaking VCE or the applied learning equivalent, and specialist school students, are attending school for face-to-face learning.

This move recognises older students are more likely to be able to social distance than younger students, ensures senior students are supported during their VCE, and acknowledges the particular difficulties of remote learning for students with special needs.

In announcing this new model, the Victorian government also revealed daily temperature checks would be introduced for all students attending school face-to-face in term 3.

The details

The Victorian government pledged to supply schools in Melbourne, Mitchell Shire and surrounding areas with more than 14,000 non-contact infrared thermometers. These are the type of thermometer positioned from a distance, generally towards a person’s forehead, to take their temperature.

In the case a student records a temperature of 37.5℃ or above, the school will contact the student’s parent or guardian to take the child home, and encourage them get a COVID-19 test.

While some Victorian students are back at school, most are learning from home again.
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The temperature checks are designed to detect fever as an indicator of possible SARS-CoV-2 infection. But there are a couple of things we need to keep in mind when considering how useful temperature checks will be.

First, these types of thermometers won’t always reliably detect fever. And second, many children with COVID-19 won’t have a fever.

Sensitivity and specificity

A few key features are important when screening for disease. In the case of non-contact infrared thermometers, the “disease” we’re screening for is fever.

First, a tool should be able to correctly identify those with the disease (sensitivity). Second, a tool should correctly identify those without the disease (specificity). Third, a tool should have high probability that a person with a positive result does have the disease (positive predictive value, or PPV).

Testing of non-contact infrared thermometers has reported wide variation on each of these measures. One review found sensitivity ranged from 4%-89.6% and specificity from 75.4%-99.6%. Where one in 100 people had a fever, the PPV was between 3.55%-65.4%.

Non-contact infrared thermometers measure skin (peripheral) temperature without physical contact, which offers a convenient option for temperature checking large numbers of children.

But their readings can be affected by factors such as outdoor temperature, where on the body you aim the thermometer, and distance from the subject.

We also need to remember fever reducing medications, such as paracetamol, can lower a child’s temperature.

Combined, these factors indicate non-contact infrared thermometers may not be very reliable in detecting a fever (regardless of whether or not the fever is related to COVID-19).

Do children with COVID-19 have fever?

A review of studies found fever was the most common symptom in children and young people under 21 with COVID-19, recorded in 47% of cases. Other symptoms include cough (37%) and diarrhoea (4%).

Two reviews explored asymptomatic infection in children, reporting 14% and 19% of children had no symptoms at all.

This means fever screening may miss more than half of infected children in schools, as they could either have no symptoms, have symptoms that don’t include fever, or have fever not detected by the non-contact infrared thermometers.

Schools in other countries are also checking students’ temperatures.
Shutterstock

Do children transmit COVID-19 in schools?

Initial reports suggested children don’t transmit SARS-CoV-2 as much as adults, however evidence in this space is still evolving.

A NSW government report found no student-to-teacher transmission and very low student-to-student transmission.

Conversely, one of Victoria’s largest outbreaks to date occurred at a P-12 school; staff, students, and close contacts have tested positive. But it’s not yet clear how much transmission can be attributed to school activities as opposed to household and community transmission.

A recent study from South Korea found within the home, ten to 19-year-old children transmit the virus as much as adults, whereas children aged under ten transmit less than adults.

While this paper focused on household transmission, a recent study from Israel reported on an outbreak in a secondary school. It found overcrowded classrooms, lack of mask wearing and air conditioning use were likely to be contributing factors.

Schools around the world

Among countries that have now returned to school, Japan, South Korea, Taiwan and Vietnam have implemented fever screening.

France, Belgium, Germany and Israel have differing requirements for use of face masks among students and teachers.

The US Centers for Disease Control and Prevention (CDC) recommends parents check their child’s temperature before or upon arrival at school.

The use of non-contact infrared thermometers to identify children who could have COVID-19 may not be reliable.

But at the very least, this tool provides a visible important reminder to parents, staff and students of the risk of COVID-19, and for children to remain at home if they’re unwell.

Fiona Russell, Principal research fellow, University of Melbourne and Kathleen Ryan, Research Fellow, Asia-Pacific Health, Infection and Immunity Theme, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sharing my thoughts with the world from a Particular Baptist perspective

1. Vaccinate the adults around them

2. Mandate masks for teachers and students

3. Ventilated classrooms

4. Reduce numbers of people indoors

5. Test school kids

What about childcare centres?

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How are schools ventilated?

What schools need to do

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What are antigen tests?

How effective are they?

We need to trial rapid antigen testing in Australia to get reliable local information

Lessons from HIV

It’s not perfect, but it could be useful

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Schools should be a priority

Kids are not major drivers of transmission

We need a national plan on schools

School closures cause enormous strain

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It’s hard to detect COVID-19 in children

But children do transmit the virus

What we know about outbreaks in Australian schools

What we know about outbreaks in schools, internationally

What we need to do

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Technology during the pandemic

So, what now?

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1. Outbreaks in childcare and schools are driven by community transmission

2. School infections are much lower than in the community

3. Most infections in schools and childcare centres were well contained

4. Households are the main source of infection, not schools

Closing schools should be a last resort

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How likely are children to be infected?

How often do children transmit the virus?

What have we seen in schools?

Close schools when community transmission is high

The changing landscape

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Setting up Year 12s for further learning

Year 12s like learning independently

Is online learning inferior to face to face?

Tips for Year 12 students

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The details

Sensitivity and specificity

Do children with COVID-19 have fever?

Do children transmit COVID-19 in schools?

Schools around the world

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