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Commentary

Schools Closures During the COVID-19 Pandemic

A Catastrophic Global Situation

Buonsenso, Danilo MD*,†,‡; Roland, Damian BMedSci, PhD§,¶; De Rose, Cristina MD*; Vásquez-Hoyos, Pablo MD, MSc‖,**,††; Ramly, Bazlin MB, BcH, LRCP&SI‡‡; Chakakala-Chaziya, Jessica Nandipa MD§§; Munro, Alasdair BSc, BM¶¶,‖‖; González-Dambrauskas, Sebastián MD***,†††

Author Information
The Pediatric Infectious Disease Journal: April 2021 - Volume 40 - Issue 4 - p e146-e150
doi: 10.1097/INF.0000000000003052

In early 2020, school closures (SCs) were one of the first nonpharmaceutical interventions adopted around the world as a COVID-19 disease containment strategy. With the exception of east Asia, which commenced SC in January–February, by the end of march SC affected the normal academic routine of 1.5 billion learners (84% worldwide total) across 169 countries of the world.1 The rationale behind the usefulness of SC could be found in different modeling studies which suggested to apply this public health measure for influenza virus pandemics with the World Health Organization recommending SC with the H1N1 pandemic in 2009.2,3 These considerations seemed to justify the obvious harms related to SC in the short to medium term.

However, early in the pandemic, the international community realized that COVID-19 infection represented a significantly lower risk for children than adults, and that children seemed less important vectors for SARS-CoV-2 transmission than for previous respiratory virus pandemics..4–8 A growing body of evidence subsequently showed that children were not super spreaders, and it became clearer than the harms related to SC outweighed the benefits.9,10 Unfortunately, the global decision to get back to school did not mirror the rapid decision to close them. Whereas SC was almost a unanimous step, its reversal was not, and millions of children are still not attending their optimal learning environment.

To assess SC worldwide during the pandemic, we collected information from 2 different perspectives. Initially, we interviewed professional contacts from around the world who based on their knowledge allowed us to describe the situation in different countries (see figures, Supplemental Digital Content 1, http://links.lww.com/INF/E279 and 2, http://links.lww.com/INF/E280). This version was uploaded on a preprint server and shared on social media gaining an altimetric index of more than 400 within the first 24 hours and receiving several comments and “live revisions.” Secondary to feedback we subsequently updated the figures using data from the Oxford COVID-19 Government Response Tracker,11 which collects daily information on SCs from >180 counties (Figs. 1 and 2). We analyzed the timelines according to the number of days schools were open (0 or 1), partially open (2) or fully closed (3) based on the collected information (Fig. 1). We geocoded (Figs. 1 and 2) maps and also created a heat map using online available information of deaths from COVID-19 per month by country (https://ourworldindata.org/covid-cases; accessed November 20, 2020)12 to contrast with the opening of schools.

FIGURE 1.
FIGURE 1.:
School reopening timelines by country and general mortality heat map over the same period. On the left, a Gantt chart for each country grouped by regions that shows the status of the country’s schools’ functional status between January and November 2020. The schools that have their doors fully open are shown in green (Category 0: no measures taken, or category 1: governments recommend on closing or all schools were open but with some alterations). Schools with a partial opening are shown in yellow(Category 2: governments require closing at some levels or by categories like age, financing, or partial attendance schemes). The schools are closed (Category 3: government require closing all levels) are shown in red. Source: Data from the Oxford COVID-19 Government Response Tracker (https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker).11 On the right, a heat map of the general mortality behavior of each country by month, based on the report of new deaths per million inhabitants. Source: Coronavirus (COVID-19) Cases—Statistics and Research. (https://ourworldindata.org/covid-cases).12
FIGURE 2.
FIGURE 2.:
Global map of predominant status regarding school opening/closure during COVID-19 pandemic. This global map describes the prevailing situation in each country in relation to the school’s status (opening or closure) as of November 2020. In red, countries that have remained mainly closed (Category 3: governments require closing all levels) are described; the intensity of the color indicates whether this closure represents 0 to 337 days of the timeframe. In yellow, countries that have been mainly partially opened are described (Category 2: governments require closing at some levels or by categories like age, financing or partial attendance schemes). In green, the countries that where fully open (Category 0: no measures taken, or category 1: governments recommend on closing or all schools were open but with some alterations) are described. Source: Data from the Oxford COVID-19 Government Response Tracker (https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker).11

SCS AND REOPENINGS ACROSS THE WORLD DURING 2020

With few exceptions (such as Nicaragua, Sweden or Taiwan which never closed schools), SCs were widely implemented across the globe during 2020. According to UNESCO monitoring, as of November 23, there were still over 220 million learners affected by SC, with 23 country-wide closures due to COVID-19.1

Schools reopening was variable across countries (Fig. 1) and the process was not directly correlated to the severity of pandemic impact (measured by COVID-19 deaths). Africa and Europe demonstrate 2 sides of this spectrum. Although Africa has had an overall relative low death toll, most countries currently still have SC enacted. According to the UNICEF, only 7 (Benin, Burkina Faso, Cabo Verde, Chad, the Republic of the Congo, Equatorial Guinea and Sierra Leone) of 24 countries in the Central and West African region have reopened their schools after COVID-19 mandatory lockdowns.13

Conversely, most of Western Europe prioritized the reopening of schools despite having a significant second wave of COVID-19 during the autumn.14 In early November, the UK guidance for school reopening stated that “it continues to be the aim that all pupils, in all year groups, remain in school full-time throughout the autumn term” and that “returning to school is vital for children`s education and for their wellbeing.”15 Current data from European countries with similar decisions support the finding, that especially for younger children, schools are not playing a defining role in amplifying community transmission. The reopening of schools played a subordinate role in the spread of SARS-CoV2 during the second wave in Germany,16,17 and Denmark was the first Western country to reopen kindergartens and elementary schools and subsequently recorded a steady decrease in cases nationwide.18

Despite the available empirical evidence governments are acting with different strategies,6,17,19 some are more prone to keep all schools open (Northern and Western Europe), while others are more hesitant like Southern and Eastern Europe. For example, although data supports a low transmission of SARS-CoV-2 within Italian schools (specially for younger students), entire schools are frequently closed in the fear of larger outbreaks.19 In North America similar situations occurred, the first major city in the United States to reopen schools was New York in September. Surprisingly, although viral transmission remained very slow and school chancellors declaring “our schools have opened and have been remarkably safe,” policymakers decided to close them again in November with no data supporting the decision after a surge of COVID-19 cases within the city.20 These situations show drivers for SC and reopening have not always been driven by scientific evidence as the American Academy of Pediatrics policy statement suggests needs to occur.21

So far, the only peer reviewed evidence highlighting concerns with the safety of school reopening is from Israel. After enacting SC early in March and experiencing a limited first wave of infections, Israel reopened schools in May alongside most other sectors of society. However, after numerous outbreaks, Israel closed hundreds of schools and blamed educational centers for the surge in cases, forcing a total lockdown again at the end of September. In October, new analysis from scientists of the University of Jerusalem investigated these outbreaks and stated that the educational system was not the reason for the second COVID-19 wave in the country,22,23 because many other factors including residential Orthodox education, the Arab sector wedding season and families simultaneously returning from summer vacations were all correlated to the timing of reopening.

Our research and the resulting map (Fig. 2) demonstrate a profound inequality and lack of homogeneity between countries to the detriment of the poorest countries in the world which are not yet able to guarantee the safe reopening of schools.

The current situation in Latin America is dramatic. As of November, there were >13 million cases of coronavirus reported,24 almost half of country-wide closures came from this region where the schools of 18 of 36 countries remain closed and most of countries do not have clear reopening plans for the months to come. A recently released analysis from UNICEF reported that 97% of students of the region (accounting for 137 million children) remain with their normal education disrupted.25 The report estimates that 3.1 million boys, girls and adolescents will finish school for ever due to COVID-19 crisis.

An important limitation when interpreting Figures 1 and 2 is the arbitrary term “partial” which must be considered because the reopening process had huge variation between and within countries. For example, Uruguay, which decided full SC the day after detecting the first national case of COVID-19 (March 14, 2020), was also the first Latin American country which reopened rural primary schools for face-to-face teaching in April 22, 2020.26 Then urban schools were reopened in a staggered but voluntary approach throughout June in the rest of the country. Unfortunately, as of mid-November, there is no central precise data of how many students have effectively returned to classes.

IATROGENIC SOCIAL HARM RELATED TO SCs

In World War II, one of the less obvious impacts was the disruption of school learning, which may have had a negative economic impact lasting at least 40 years.27 It is estimated that every year loss of schooling equates to a 10% loss of future earnings and the additive effects across society could huge costs.28 Recently, the World Bank estimated that a school shutdown of 5 months could value $10 trillion in terms of learning losses.29 Moreover, the COVID-19-related economic recession is likely to increase funding gaps and thus put at risk the agreed 2030 sustainable development goal on education in low- and middle-income countries.30

Early in the pandemic, the United Nations warned SC could amplify gender inequalities and reverse equality progression from previous decades, particularly regarding children´s main caregivers (38) and especially for those in the most disadvantaged countries.31,32 Finally, SC could worsen an already severe food security crisis during COVID-19 crisis.33 According to the World Food Program from WHO, 80 million students in Latin America cannot access healthy food and are now at risk of nutrition deficiencies with potential impacts on mortality.

Prolonged interruption of child education services also deprives children of the learning experiences necessary for their full development, especially a stage of their life when they need it most. SCs are having a significant negative impact on each student’s learning and their ability to develop critical thinking and social skills.34 The most disadvantaged children—including those with cognitive and physical disabilities, refugees and migrants and girls in particular—face even greater exclusion from the learning process. In countries where inequalities are more pronounced, boys and girls, without school to attend, are more vulnerable to issues such as early pregnancy, child marriage and recruitment into local armed groups.30

There are also hidden pandemics during the COVID-19. SC forces children to spend more time within their homes where most child abuse occurs. It should not be a surprise in times of economic recession and severe socioemotional stress and uncertainty that a wave of violence occurs against children. Besides physical harm, a rise on mental health disease is likely to arise, as SC remains.35

FUTURE STEPS TOWARD A BLURRED HORIZON

Investments in public education need to be protected and incentivized so that schools can be physically ready for opening by providing water, sanitation and hygiene as soon as possible.13,36 In this way, in a future prospective, governments can “rebuild better,” laying the foundations for education systems to provide not only better learning, but also a safer and more resilient environment than which existed before the pandemic. Many schools even in high-income countries are in dilapidated buildings which have proved difficult to provide sufficient ventilation for optimum infection prevention.37 “With every day that goes by, millions of children and young people unable to safely access learning opportunities are missing out on their right to an education and putting their future at risk,” regional director Marie-Pierre Poirier said in a statement,36 one reason UNICEF have proposed a 6-point plan to avert a “lost COVID generation.”38

Schools have always been at the heart of the rights of children and adolescents and their families. Technically leaving students at home from primary to high school contravenes the UN Convention on the rights of the child signed by the States parties “the right of children to education, and with a view to achieving this right progressively and on the basis of equal opportunity.”39

CONCLUSION

The approach to the reopening of schools has been chaotic and fragmented, both internationally and even within national borders. There has been a lack of impetus in many countries to recognize the essential nature of educational facilities in the health and well-being of children, and a disproportionate focus on their potential role in disease transmission due to the framing of previous influence pandemics. The issues are exacerbating entrenched inequalities within nations, disproportionately harming children and families who are already the most vulnerable. At a global level, schools have been reopened predominantly in wealthy nations in North America and Western Europe, while they remain closed across swathes of the continents of South America and Africa, lead to deepening health, social and economic divides between high- and low-/middle-income countries. A coordinated global effort is required to urgently return children to in person schooling (with a focus on the youngest children) to prevent further harms to the futures of children and young people and stem the tide of deepening inequality.

ACKNOWLEDGMENTS

We are thankful to the social media community that, after uploading the preprint of our manuscript, contributed with a productive discussion in improving the analyses and representation of SCs worldwide. We are grateful to colleagues from all over the world that supported this study providing national data about SC: Luis Llano, Roberto Jabornisky, Diego Vinciguerra, Nils Cassoon, Regina Grigolli, Vanessa Lanziotti, Pietro Pietroboni, Adriana Yock, Valeria Defaz, Alcides Díaz Claros, Rubén Ruíz Santa Cruz, Millie Figueroa, Jesús Domínguez, Amadu Juliana, Miguel Angel Luzardo Urdaneta, Miguel Rodríguez-Rubio, Francisco Abecasis, Sebastian Baier-Grabner, alix Flamant, Mihael Plosnic, Andreea Madaline Panciu, Pietro Sollena, Johanna Lempainen, Silvia Simò Nebot, Amelie Sandart, Yonca Bulut, Vira Chechenyeava, Arun Bansal, Bahareh Yaghmaie, Hussam Inany, Jackie Ong, Rashan Haniffa, Qalab Abbas, Ryuichi Waseda, Fiona Muttalib, Hussam Inany, Emma Luisa Binns, Chifuniro Kamwendo, Jana Rodríguez-Hertz.

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