Local paediatric doctors have joined the Paediatrician Management Group (PMG) and the South African Paediatric Association (SAPA) in expressing concern about a recent cabinet decision to close all public schools.
In a joint statement, the two associations, which represent all paediatricians in South Africa, stated that it believed that the decision was not based on best available scientific evidence and was not in the best interests of children in South Africa.
“We have taken note of all the conflicting views expressed by government, teacher trade unions, political parties, civil society, school governing bodies and parents. We remain sympathetic to all parents/caregivers, children and teachers who are fearful and anxious. However, we are of the opinion that is in our children’s best interests to return to school,” the associations said in the statement issued on Tuesday.
The organisation pointed out that in South Africa children accounted for 5% of cases.
“South African case distribution by age data confirms that 5-9 years old have an incidence of 15 per 100 000 population; 10-14 years old have an incidence of 22 per 100 000 population and 15-19 year old have an incidence of 38 per 100 000. In comparison the incidence in the 20 to 60 year old groups varies between 94 to 228 per 100 000 population.”
It stated further that a recent media statement released by the Western Cape Education Department (WCED) confirmed that only 0.1% of all pupils who had returned to school tested positive for SARS-CoV-2 and no deaths of pupils were reported to the WCED. “Although this percentage is affected by the current Western Cape testing strategy, it is nonetheless reassuring that the reopening of schools have not resulted in any significant outbreaks at a population level.”
“Children and young people have a lower susceptibility to SARS-CoV-2, with 56% lower odds of being an infected contact.”
The organisations stated further the family cluster/household studies showed that children were rarely the index case and that children seldom cause outbreaks, while children’s risk to contribute to school outbreaks was very low.
“There are no reported large outbreaks in schools in any country. This supports the argument that asymptomatic children attending schools are unlikely to spread the disease.
“In the Western Cape (WC) more than half of the schools have not reported a single positive case despite very high community transmission in the WC at the time of the reopening of schools. In the schools who have reported a case, 72% reported only 1 or 2 cases. As of July 16, there were only 333 (0.8%) active Covid-19 cases amongst WCED staff, indicating that teachers are not at greater risk than other essential workers. There have been no reported outbreaks in WC schools and weekly new staff cases have been decreasing since the reopening of schools despite ongoing high community transmission rates.”
“There is no reported South African data that proves that reopening of schools played a significant role in community transmission rates.”
Children also have a much milder disease than adults and deaths are extremely rare. “By the June 9 2020 only 2.6% of all Covid-related admissions in South Africa were for children 0-18 years and only 0.4% of all Covid reported deaths were in children 0-18 years.
“SARS-CoV-2 has caused less childhood deaths compared to Influenza from the onset of the SARS CoV- 2 pandemic.”
“During the South African Influenza season of 2017 an estimated 580 children died of Influenza, while injury-related deaths continued to dominate as the number one cause of paediatric mortality during 2020. Using StatsSA data from 2016, Prof Servaas van der Berg and Dr Nic Spaull from Stellenbosch University, estimated the regular mortality risk for ages 0-19 years in SA is a 1 in 1 000 chance, while the projected Covid-19 mortality risk in the same age group is 1 in a 76 000 chance (0.001%).”
The organisations stated further that even though there was scant data on the role of co-morbidities in children, the Department of Basic Education (DBE) had already made provision to allow high risk pupils to stay at home.
“In addition, all school staff members with co-morbidities have also been allowed to stay at home without any loss of income. Therefore, those who have been and would be attending school are per definition, not high risk.
“There is no clear evidence that school closure results in a significant reduction in community transmission or overall deaths. A Covid-19 modelling study done in the UK which was based on the previous H1N1 epidemic and the SARS outbreak, predicted that school closures alone would possibly prevent only 2-4% of deaths. This is much less than other social distancing interventions.”
They pointed out that access to basic education was a basic human right enshrined in our constitution.
“By the end of August the majority of pupils would have missed half of their school year. Only about 20% of school children have access to online schooling according to the DBE and it is estimated that only 10% of households have internet access. This lack of access to education is disproportionally affecting vulnerable and disadvantaged children. The knowledge and skill gap between those with access and those without will only continue to increase and this loss of education will have long term and far reaching economic effects.”
The associations pointed out that the DBE had not implemented any meaningful strategies since March to mitigate any of these effects and a significant percentage of pupils had not received any educational material since March 2020.
“In 2018, 77% of children in public schools, approximately 9 million children, received a school meal every school day. It is still unclear how schools plan to continue with the feeding scheme without any staff members present or how caregivers/children will collect the meals.”
The emotional and psychological effects on children during and after lockdown was also reported to be immense. “Recent international reviews show that lockdowns, school closures and natural disasters raise levels of substance abuse, depression, domestic violence and child abuse.”
“School closures increase childcare obligations, especially of healthcare or essential workers. By reopening the economy while keeping schools closed, many parents/caregivers are forced to leave their children at home unattended. It is estimated that more than 2 million children aged 0-15 years will be left at home unattended, increasing their risks for accidental injury, abuse, fear, anxiety and isolation.
“To date, it has been clear that transmission rates vary greatly between provinces, with the Western Cape leading initially, followed by the Eastern Cape and now Gauteng. Current international data suggests that countries may experience multiple peaks over the next 12 months. It is therefore unclear when the teacher unions and the cabinet would consider it “safe” again to reopen schools if the so-called “peak” varies geographically and is difficult to predict. It seems illogical to close all schools in all provinces and districts if community transmission rates vary so significantly. Allowing school communities to monitor and manage their risks based on local transmission would enable more schools to continue with their school activities and limit interruptions over the next 12 months.
“In our view as paediatricians the benefits of attending school still outweighs the risks. Public schools should be allowed to reopen. School communities should be allowed to reopen their schools immediately if they are able to do so safely. Those school communities who are at risk, either due to high local transmission rates, or poor infrastructure should be identified and supported immediately to mitigate their risks so that they can reopen as soon as possible. Where schools are unable to reopen, the DBE must still ensure that all learners continue to have safe access to feeding schemes and adequate academic material via radio, television, cell phone applications and all other means necessary. Educators must be held accountable for providing ongoing academic support and material at all times.”
The associations urged the government to place the health, well-being and needs of children as their first and foremost priority and to not allow fear or politics to harm the children of South Africa.