Today I attended an online webinar titled: Getting children back to school safely. Taking into account my own and other parents anxieties around whether or not to send children back to school, this was a very useful webinar, which answered many of my concerns. The webinar had a panel of experts who have done extensive research into the impact of COVID19 on children, drawing from global research, in areas in which the pandemic has hit and children continued to attend school or have resumed schooling after lockdown restrictions were lifted. As we have not reached this point yet as a country, it is valuable to look to those who have and learn from their experiences.
3 questions formed the basis of the discussion, namely:
Do children get covid19?
Are children covid19 super spreaders?
How can we make schools relatively safe?
The first speaker Professor Refiloe Masekela , Pediatric Pulmonologist and the Head of Department of Paediatrics and Child Health at the University of KZN, Durban, South Africa, answered the first question. In summary what I gathered from her discussion was that children aged between 0-19 years are less affected then the adult population. There is something specific in children which seems to protect them from the virus. She explained the virus, which is a respiratory virus, requires a certain receptor to break through our body and cause infection. She referred to a receptor called ACE2 (forgive me I’m not a doctor, so these terms were rather foreign to me, as I tried to keep up with the discussion), which is immature in children. From a very brief google search, I discovered that ACE2 is a specific protein that allows the virus to infect human cells. Called the angiotensin-converting enzyme 2 (or ACE2 receptor), the protein provides the entry point for the coronavirus to hook into and infect a wide range of human cells.
She further explained that children have fewer of these receptors in comparison to adults and may this contribute to understanding why the infection rate is lower in children in comparison to adults. She also explained that children’s immune system play a part, as it is considered to be more robust then adults aging immune system. If we think about it, it makes sense, our little ones are always putting their fingers in their mouths, fingers which have touched various surfaces, which contain various germs. Thus, she states that children have other viruses in their upper respiratory tract and COVID19 has to compete with these viruses in order to affect children. Furthermore, she highlighted that most children have fewer chronic diseases in comparison to adults, such as hypertension etc.
She then went on to discuss typical symptoms that may present in children. I found this interesting, as schools are getting ready to receive children and highlight as part of their preventative measure they will be having thermo-scanners. Prof. Masekela stated that the presentation of fever in children is rare, some may exhibit coughing, but key symptoms to look out for in children include:
-sore or red throat
-runny nose
-diarrheoa
She also emphasized that children may also present as asymptomatic (no symptoms) or with mild symptoms but majority are unlikely to require hospitalization. Among children, high risk groups were identified and included children under the age of 1 (possibly since their immune systems are still developing) and those with comorbid health conditions, those listed were: Chronic diseases in chest (lung disease); Chronic asthma (Mild or moderate asthma not at high risk, if well controlled); Cardiac disease and severe neurological disability; and Immunosuppression. Dr. Moherndran Archary (a panel expert who I will elaborate on later) added to this by stating that children who may get infected and do not have comorbid health issues may recover themselves, as children’s immune systems are robust. Recommending bed rest, hydration and nutritional needs are met.
Professor Sithembiso Velaphi, a Pediatrician, Associate Professor with the University of the Witwatersrand and Head of Pediatrics at the Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa, answered the second question, highlighting that the viral load in children is lower than in adults and yes they can affect others but are less likely to. Why you ask? Well firstly, because of the lower viral load, lower tidal volume (breathing lower) and coughing or sneezing less forcefully then an adult. He further stated prevention is better than cure and it is important to maintain social distancing, hand hygiene and screen for symptoms, as we need to remember that we are not isolated beings and children coming home from schools need to be educated about hand hygiene, especially if they have elderly at home or vulnerable individuals.
Doctor Moherndran Archary, a Pediatrician Infectious Disease Specialist in the Department of Pediatrics and Child Health at King Edward VIII Hospital affiliated to the Nelson R Mandela School of Medicine at the University of KZN, Durban, South Africa, than answered the third question: making schools relatively safe. He acknowledged that for parents the priority is keeping their children safe and acknowledged the confusion media and other reports may be giving: keep kids home when numbers were low versus send kids to school when numbers are high. How does this make sense? He explains that the pandemic will be with us for the next 1 to 2 or 3 years (if a vaccine does not materialize) and since we have not yet reached our peak, we have limited data and as time goes the data is evolving and developing further. Thus, they have learnt more about the virus over time and this has shown that children are not as severely affected. He draws on various research samples from various countries, as do the other speakers, to make this point. I will post the link to the webinar recording as soon as it is released so you can have a look at this and fill in any info gaps you may have after reading this post.
Dr. Archary also emphasized that the virus will hit us in waves and that the next wave is expected in the next 2 to 3 months. Thus, his presentation on a risk mitigation strategy was very useful for me, as I thought about the reality of keeping my child at home for 2 to 3 years or biting the bullet and finding a way to live with our new normal. His presentation looked at what schools needs to have in place for students return. I think all school heads should have a look at this as they prepare for the reopening of schools. I have attached pictures of his slides which explain these safety measures. It is our responsibility as mental health professionals, teachers, parents and citizens to ensure that the measures are put into place and help our schools to resume some form of educational normalcy, as this may be our new normal for the next 2 to 3 years.
Prof. Masekela also reflected on the impact of keeping children out of school on their mental wellbeing, as children are isolated, have limited peer support and structure is taken away, which could result in feelings of depression and anxiety. Mental health a key issue that is often forgotten as we focus on physical health during this pandemic. We need to be mindful that this is a difficult and anxiety provoking experience for our children too and finding helpful ways to engage with this is important for their mental wellbeing, as well as our own as the adults that are their caretakers.
Written by Sumaiya Mohamed (Senior Psychosocial Trauma Professional)
The Centre for the Study of Violence and Reconciliation 