CONSIDERATIONS FOR HEALTH AND EDUCATIONAL AUTHORITIES ON THE PUBLIC HEALTH AND SOCIAL MEASURES TO REOPEN SCHOOLS AS SAFELY AS POSSIBLE SCHOOLING IN TIME OF COVID-19

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Considerations for health and educational authorities on the public health and social measures to reopen schools as safely as possible

Developed by: This document was developed by Kalpana Vincent (Social and Behaviour Change

Consultant, UNICEF Regional Office for Europe and Central Asia), Viviane Bianco

(Social and Behaviour Change Specialist), Sarah Fuller (Education Consultant,

UNICEF Regional Office for Europe and Central Asia), Jessica Katherine Brown

(Early Childhood Development Specialist, UNICEF Regional Office for Europe and

Central Asia), Cristiana Salvi (Regional Advisor, Risk Communication and

Community Engagement, WHO Regional Office for Europe) and Olha Izhyk (Risk

Communication and Community Engagement Consultant, WHO Regional Office for

Europe,)

Photo credits Front cover: © UNICEF/UN0362379/Serbia/Nemanja Pancic

Contents: © UNICEF/UN0469726/Bosnia and Herzegovina/Goran Djemidzic

Page 4: © UNICEF/UN0419787/Armenia/Narek Margaryan

UNICEF Regional Office for Europe and Central Asia

WHO Regional Office for Europe

October 2021

© United Nations Children’s Fund (UNICEF), 2021.

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CONTENTS Introduction …………………………………………………….. 4 COVID-19 transmission in the school setting………………. 4 COVID-19 transmission in children ……………………….… 5 Considerations to ensure the reopening of schools as safely as possible……………………………………..……..... 6

§ Maintain physical distance § Ventilation and air-condition use § Hand hygiene § Promote vaccination of teachers and other school staff § Usage of masks § Testing

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INTRODUCTION

Education is too important to keep all-remote.

The loss of an unprecedented amount of

classroom time has resulted in social,

developmental, learning and emotional

setbacks that negatively impacted students’

physical and mental health and well-beingi for

yearsii. It has widened inequalitiesiii and

disproportionately affecting children from less-

advantaged backgroundsiv. Given the adverse

effects of school closures on the health and

well-being of students, the interruption of face-

to-face learning should be considered only as

a measure of last resort. There are huge costs

to such interruption. It is long past time to stop

making children pay that price.

The return to face-to-face learning helps

children return to a sense of normality,

although different normality as prevention and

control measures have likely altered school

and classroom routines. Attending the school

also opens up the opportunities to interact

with teachers and peers and receive

psychological support. Importantly, a return to

the classroom delivery of education means

children can get back to learning with

adequate support to recover what they have

missed over the course of the past 18 months.

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COVID-19 TRANSMISSION IN THE SCHOOL SETTING

The majority of studies indicate that in-school

transmission was generally lowv when schools

layered several kinds of safety measures such

as usage of masks, symptom screening,

physical distancing, improved ventilation and

rate of vaccinated population of teachers and

other school staff. Though transmission can

occur within school settings and clusters have

been reported by countries in preschool,

primary and secondary schools, it is

influenced by the local levels of community

transmission. It has also been identified that

COVID-19 transmission in the school setting

was not a primary determinant of community

transmission in the earlier phase of the

pandemicvi-vii-viii. A global study that tracked

school closures and subsequent re-openings

data in 191 countries showed no association

between school status and COVID-19

infection rates in the community in the earlier

phase of the pandemicix.

It is of paramount importance to understand

the transmission of COVID-19 in schools and

communities. During the first and second

waves of the pandemic, there has been a

limited spread of COVID-19 in schools. The

cases reported most often in teachers and

other staffx and showed that the risk of adult

to adult transmission is higher than the child

to child or child to adult transmission. With the

emergence of new variants, the susceptibility

and infectiousness of children, adolescents

and educational staff are currently higher and

thus the likelihood of transmission in the

school setting is also higher.xi

COVID-19 TRANSMISSION IN CHILDREN

Children figure amongst the unvaccinated

populations in countries with the subsequent

vaccine roll-out and as a result, more COVID-

19 transmission is expected to occur in the

school setting, particularly when community

activity levels are highxii. Transmission in

school settings can be limited if effective

mitigation and prevention measures are in

placexiii.

Worldwide, relatively few children have been

reported with symptomatic COVID-19.

Children become less seriously ill compared

to older persons and rarely need to be

hospitalisedxiv. During the winter of 2021, the

infection rates have increased sharply in

children aged 5-14 years of age in other age

groups. Most children with COVID-19 are

symptomatic or have mild symptoms and a

very low risk of deathxv. Although very rare,

some children develop significant respiratory

disease and require hospital admissionxvi.

Those children who do require hospitalisation

or who have more severe outcomes often

have underlying chronic conditions. There is

no evidence of a difference by age or sex in

the risk of severe outcomes among children.

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§ It is important that schools should

have a risk-mitigation strategy in

place.

§ Countries should ensure these

strategies carefully balance the likely

benefits for, and harms to, younger

and older age groups of children when

making decisions about implementing

infection prevention and control

measures.

§ Any measure needs to be balanced

with the even worse alternative of

schools being closed and

§ Any measure introduced by schools

should follow standard protocols for

implementation.

CONSIDERATIONS TO ENSURE THE REOPENING OF SCHOOLS AS SAFELY AS POSSIBLE

Maintain physical distance

WHO advises that schools should consider

maintaining at least one-metre distance

between everyone present at school.

• Increase spacing between students’

desks or spots on a bench at a

minimum of the one-metre between

desks. If the classroom is small,

consider splitting students into two

classrooms. Teachers can rotate

across classes if necessary. Different

subjects can be taught if teachers for

the same subjects aren’t available at

the same time. Moving classes

outdoors or to spacious rooms such as

auditoriums or cafeterias would help

facilitate distancing.

• Teachers should consider maintaining

the distance between themselves and

their students whenever possible and

during instruction.

• Markings on the floor and benches

(with paint, tape or stickers) might be

advised to help students and teachers

recognise the distance.

• Keeping students in small groups help

in keeping the proximity between them

and aid in contact tracing when an

infected individual at the school has

been identified.

• School days can be staggered to vary

the start and end times according to

the grades, hall passing periods and

mealtimes. It helps to avoid having all

the students and teachers together at

once.

Ventilation and air-condition use

WHO recommends improving air quality

(ventilation) naturally by opening windows

when it is safe and possible to bring fresh air

from outdoors. The larger the number of

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people in the indoor setting, the greater the

need for ventilation with outdoor air.

• Consider moving unmasked activities

such as eating or activities that release

high amounts of respiratory droplets

like singing, recitation, sports or

exercise to outdoors.

• Ensure adequate ventilation and

increase total airflow supply to

classrooms and communally shared

spaces when it is occupied.

• If heating, ventilation and air

conditioning (HVAC) systems are

used, regularly inspect, maintain and

clean them.

Promote hand hygiene Hand cleaning is one of the most important

measures to avoid the transmission of germs

and prevent the spread of COVID-19.

• Encourage students to wash hands at

key times with soap and water for at

least 40 seconds or hand rub using an

alcohol-based hand sanitiser with 60%

to 80% of alcohol for at least 20

seconds. Supervise young children

when they use hand rub to prevent

them from swallowing alcohol.

• Increase access to maintenance of

handwashing facilities with running

water and reliable supplies stations or

facilities such as sinks, portable

handwashing stations and hand rub

dispensers.

• Consider making hand rub available

for teachers, students and other

educational staff where soap and

water aren’t readily available (e.g.

classrooms and gyms) and near

frequently touched surfaces (e.g.

doors and shared equipment such as

musical instruments, sports gear etc.,).

• Regularly clean and disinfect

frequently touched surfaces to kill

germs. Ensure that all cleaning

materials are kept out of reach of

children.

Promote vaccination of adolescents, teachers and other school staff WHO recommends (relates to use of

Pfizer/BioNTech vaccine) adolescents from

12-17 years with severe chronic comorbidities

and those who are in contact with vulnerable

individuals including the teachers and other

school staff should be considered as part of

priority population groupsxvii-xviii in the national

vaccination plans while first ensuring

vaccination of older adults, vulnerable

populations and people with underlying health

conditions, who are at higher risk of severe

COVID-19 infection.

There is substantial evidence that schools can

reopen safely without vaccinating children,

particularly in the presence of other risk

mitigation strategiesxix. However, encouraging

vaccination of teachers and school staff

vaccination is critical to their risk of infection

and further transmission in schools.

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• Provide updates about COVID-19

vaccination through regular

informational and educational

sessions.

Usage of masks

WHO advises that people always consult and

abide by national and local authorities on

recommended practices in their area. WHO

and UNICEF recommend the following:

• Children aged five years and under

are not required to wear masks.

• For children between six and 11 years

of age, a risk-based approach is

encouraged, consider:

o The intensity of transmission in

the area where the child is and

evidence on the risk of

infection and transmission in

this age group.

o The child’s capacity to comply

with the correct use of masks

and availability of adult

supervision.

o The potential impact of mask-

wearing on learning and

development.

• Children and adolescents 12 years or

older should follow the national mask

guidelines for adults.

• Teachers and support staff are

required to refer national guidance to

wear masks.

• Students should not wear a mask

when playing sports or doing physical

activities such as running, jumping or

on the playground.

• Students of any age with

developmental disorders, disabilities or

other specific health conditions should

be assessed on a case by case basis

by their parents/caregivers, educators

or medical providers for the usage of

masks.

• Students with severe cognitive or

respiratory impairments with difficulties

tolerating a mask should not be

required to wear masks.

Testing

Robust testing can help promptly identify and

isolate cases and quarantine those who may

have been exposed to COVID-19 to interrupt

the chains of transmission. This helps to

reduce the risk of students, teachers and

educational staff being infected.

• In response to the school outbreak,

schools administrators can work with

local public health authorities and

request a temporary testing location.

• If a confirmed case is identified in the

school setting, activate contract-

tracing protocols to find where the

source of infection may have occurred

– schools, households and other

relevant settings.

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i United Nations (2020). Policy Brief: The impact of COVID-19 on children. ii Kuhfeld, Megan, and Beth Tarasawa. ‘The COVID-19 slide: What summer learning loss can tell us about the

potential impact of school closures on student academic achievement.’ NWEA white paper, 2020. iii United Nations (2020). Policy Brief: Education during COVID-19 and beyond. iv European Centre for Disease Prevention and Control (2020). COVID-19 in children and the role of school

settings in COVID-19 transmission. v European Centre for Disease Prevention and Control (2021). COVID-19 in children and the role of school

settings in COVID-19 transmission; 2021. Second update. vi World Health Organisation (2021). Schooling During COVID-19. Recommendations from the European

Technical Advisory Group for schooling during COVID-19. vii European Centre for Disease Prevention and Control (2020). Questions and answers on COVID-19: Children aged 1-18 years and the role of school settings. viii UNICEF (2020). In-person schooling and covid-19 transmission: A review of evidence. f ix Insights for Education, 2020. x What settings have been linked to SARS-CoV-transmission clusters? (2020). xi European Centre for Disease Prevention and Control. COVID-19 in children and the role of school settings in

COVID-19 transmission; 2021. Second update. xii European Centre for Disease Prevention and Control. COVID-19 in children and the role of school settings in

COVID-19 transmission; 2021. Second update. xiii Schooling during COVID (2021). Recommendations from the European Technical Advisory Group for schooling during COVID-19. xiv European Centre for Disease Prevention and Control (2020). COVID-19 in children and the role of school

settings in COVID-19 transmission xv Bhopal, S., Bagaria, J., Olabi, B and Bhopal, J. Children and young people remain at low risk of COVID-19

mortality (2021). xvi Preston, L., Chevinsky, J., Kompaniyets, L., Characteristics and Disease Severity of US Children and Adolescents Diagnosed with COVID-19 xvii World Health Organization (2021). WHO SAGE Roadmap for prioritising uses of COVID-19 vaccines in the

context of limited supply. xviii World Health Organization (2021). European Technical Advisory Group of Experts on Immunization (ETAGE) interim recommendations. Inclusion of adolescents aged 12-15 years in national COVID-19 vaccination

programmes. xix World Health Organization (2021). WHO SAGE Roadmap for prioritising uses of COVID-19 vaccines in the context of limited supply.