Australian Health Protection Principal Committee (AHPPC) statement on COVID-19, schools and early childhood education and care
A statement from the Australian Health Protection Principal Committee (AHPPC) on COVID-19, schools and early childhood education and care.
The position of AHPPC is that schools are an essential service and should open and remain open whenever possible. The committee recognises the wide-ranging benefits for students and the community when schools are open and face-to-face learning occurs.
Evidence to date indicates that the Delta variant does not cause more severe disease in children than previous variants of COVID-19. In recent outbreaks, 98% of infected children have not developed severe disease. The Delta variant is however more infectious and easily spread. Whilst for the most part children do not develop severe disease, if the total number of COVID-19 infections in children is large, some may have severe disease. However, well controlled disease, with transmission potential around one, means there is less opportunity for students to become infected in the community.
Multiple interventions can reduce the likelihood of infection in a school. All infection prevention and control rely on multiple layered interventions that can work synergistically to protect individuals in a hierarchy of controls.
Schools already have instituted many of these control measures when there has been COVID-19 transmission in the community. Some examples for each are listed below.
- Elimination – Remote learning, permit only essential adults on site,
- Substitution – students and staff do not attend school if unwell, screening students for symptoms,
- Engineering – consider options to enhance ventilation, environmental cleaning, physical distancing,
- Administrative – altering routines to be more COVIDsafe, grouping of students,
- PPE – use of surgical masks by adults and some students.
The goal is to reduce transmission for the entire school community, protect the unimmunised population of students at school and maintain the ability of schools to remain open. Using actions from the hierarchy of controls, three specific principles apply to minimise disease in schools.
- reducing opportunities for introduction of the virus to schools,
- reducing transmission of the virus if it is introduced, and
- early use of containment measures if spread occurs.
Each of these principles has actions that should be considered in when planning re-opening of schools noting that multiple steps will need to be taken and that these will need to be tailored by individual schools to be most effective. Measures that are implemented should be evaluated for effect, cost-effectiveness, feasibility, sustainability and adverse consequences.
Principle 1. Reducing the opportunities for the virus to enter the school population
- Unwell students and teachers should not attend school regardless of vaccination status.
- Encouraging all vaccine-eligible adults who volunteer or are otherwise engaged by the school are fully vaccinated before they enter a school; and encouraging all vaccine-eligible adults who visit a school to be fully vaccinated.
A vaccinated person is less likely to introduce COVID-19 to the school. For the most part this applies to adults, including teaching and non-teaching staff. However, as vaccination rates increase in those aged 12– 17, this principle can be considered for this age group. It is possible in 2022 that younger students may also be able to be vaccinated.
- Reduce the chance of students being infected and introducing the virus to the school by vaccinating adults and siblings/students over the aged of 12 years old around them.
Students cannot introduce the virus to the school environment if they do not become infected. Whilst children under 12, and those over 12 who are unvaccinated, remain susceptible to the disease, their opportunities to acquire infection are reduced if the adults around them are vaccinated. This is a process called cocooning that is also used for other infectious diseases in infants. High vaccination rates amongst school family units will be a key protective factor.
- Parents can reduce the chance of students being infected by reducing the size of their social group.
The chances of a child becoming infected are further reduced if they have fewer contacts with unvaccinated persons/other children outside of their own school group in the short term. This rationale has been used overseas to limit children’s attendance in after school and inter-school activities.
- If community transmission is high, consider testing to screen students and teachers before attendance.
Evidence shows that COVID-19 transmission occurs both from people with and without symptoms. If there is widespread community transmission of COVID-19 in the local community, health and education departments may consider instigating testing of students, staff and others entering a school to reduce the opportunity for introduction of the disease.
Principle 2. Reduce the opportunities for the virus to transmit if it is introduced to the school population
Schools have already instituted COVID-safe measures to reduce transmission in their setting. These methods include personal infection prevention actions such as hand hygiene, respiratory hygiene, physical distancing and mask use alongside environmental cleaning. Other actions can reduce the opportunities for transmission.
- Reduce total student numbers each day
Reducing the number of students on campus at any one time may reduce the risk as there are less students to interact with each other. Some areas are achieving this by different year levels attending on different days with remote learning on other days. Cohort (bubbles) groups of students and staff where feasible
Maintaining separate cohorts, such as year group ‘bubbles’, reduces the prospect for the virus to pass across the cohorts. Adults working in the school also need to stay in the planned bubble and restrict their contact with other adults. Maintaining separate staff groups is important as outbreaks in many work settings resulted from adults mingling in break rooms or tea rooms.
To assist in maintaining ‘bubbles’ it may be possible to reorientate the school grounds, with dedicated year level entrances, play areas and staggered entry into and exit out of school, and staggered breaks.
- Consider ventilation
We know COVID-19 spreads in the air via small and larger particles. Larger particles can infect persons nearby which is the rationale behind physical distancing. Smaller aerosols can travel further and remain suspended in the air and then be inhaled. Addressing ventilation is recommended.
As less transmission of COVID-19 occurs outdoors, using outdoor areas as learning spaces will also help in reducing spread. This needs to be balanced with available sun safety and temperature considerations.
- Maintain personal hand and respiratory hygiene and cleaning practices
- Consider mask use
As with all measures, masks are one of the options to reduce the opportunity for transmission. Masks are effective in reducing spread from an infected person (source case) and, to a lesser extent, protect a person from inhaling the virus. If used, masks must be worn correctly to cover the nose and mouth unless when eating or required to be removed for effective communication (which is of particular importance to learning in an educational setting).
Principle 3. Cases at a school, respond to contain the spread
Public health units will advise on the actions to take when cases occur in a school. However, when community transmission is widespread, large numbers of schools may have exposures to cases. Schools should be prepared to know the ‘bubble’ contacts of a student or staff member and arrange their management to be away from school for the quarantine period and advice to seek testing.
To maintain learning, quarantining the bubble of the positive case is preferable if cohorts have been maintained as it will allow the rest of the school to remain open. If cases emerge across multiple bubbles, public health advice will be needed to consider action for the wider school.
Specialist schools for specific purposes
Some school settings have students with greater risk of severe disease because of the vulnerabilities in the school population. The same principles of preventing incursion of the virus and preventing spread through personal, environmental, and organisational actions can reduce the likelihood of outbreaks of disease in these settings.
There is a stronger public health imperative to encourage vaccination of staff (and students) when the school caters for the needs of students with disability.
Early childhood settings
Most young children who get COVID-19, including the Delta variant, have mild disease. The best method to protect all children from the disease is to ensure vaccination of those around them who are able to be vaccinated. Even though disease is typically mild in children, it is worth taking actions to prevent transmission in early childhood settings where outbreaks may occur. Delta spreads more readily than other variants, including in children.
Steps can be taken to prevent incursion of the virus into early childhood settings. Anyone with new respiratory symptoms, including children, parents and staff, should stay home and arrange to be tested for COVID-19 as soon as possible. Staff members will have high rates of vaccination but need to be aware that COVID-19 breakthrough infections can occur and whilst mild, can still be a source of transmission.
Actions in early childhood settings can prevent transmission of the virus to others if it is introduced. This includes well established COVIDsafe practices of hand and respiratory hygiene, good ventilation, regular environmental cleaning and mask wearing by all adults. International studies have shown that transmission in early childhood education centres is highest between staff, and second highest from staff to children. Staff need to maintain physical distancing from each other particularly in areas prone to crowding such as tea rooms. Where feasible, establishing groups of children into ‘bubbles’, and/or grouping siblings where appropriate, moving lessons and activities outdoors, where possible, to allow safe and effective physical distancing in fresh outdoor air will reduce the opportunities for transmission between groups and limit the number of persons who may need to quarantine if a case emerges.
Where prevention strategies have been in place, the spread of disease within early childhood settings has been shown to be low.
When school transmission occurs in the future, the aim of a public health response is to reduce the number of children becoming infected. The aim is also to reduce the likelihood of needing to close a school. Communication that every school has a COVIDsafe plan and actions in place to reduce transmission will be important.
In some situations, closures may occur. If an outbreak is rapidly escalating in a community, school closures may be required to allow some time to regain control of the outbreak. This is also the case when COVID-19 is newly introduced into an area and vaccination rates are not sufficient. If used, this is for the benefit of the entire community.
The period of re-opening and return to school, if they have been closed, will be a large adjustment for those students who have been learning at home. All members of the school community will need to be aware of the stressor for students and staff with such a change.
AHPPC acknowledges the benefits of education on-site at schools and also appreciates the apprehension some people hold about transmission of COVID-19 in schools. Most children who get COVID-19 have mild disease. Vaccination of all adults around children is the most effective way to protect children from disease. All members of a school community can help to prevent introduction of the virus to students. Routines in schools can reduce the breadth of spread when it occurs.