Three in four New Zealand schools are dealing with active Covid-19 cases, and there has been a 40% rise in reported school infections since Monday.
Yesterday the Education Ministry reported more than 64,500 cases in schools, kura and early childhood centres over the previous 10 days. The situation varies across regions – close to all schools in Taranaki, Whanganui, and Manawatū have Covid cases. Aiming to keep education open where possible, the government has now announced schools and other learning settings can opt in to receive RAT tests for symptomatic people in the school community.
The SMC asked experts to comment.
Dr Amanda Kvalsvig, Epidemiologist and Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:
“New Zealand is currently experiencing its most serious infectious disease outbreak in 100 years, and this infection needs to be taken seriously. Omicron outbreaks elsewhere have had high acute impacts on children, and there are rising concerns about longer-term harms to children’s health from Covid-19 infection. It’s time for Aotearoa New Zealand to pivot to a whānau-centred approach that actively protects the wellbeing of this generation of children during the Omicron outbreak and beyond.
“A first step would be for NZ to revisit its schools policy. The current policy (“closing schools is the last resort”) is exposing a significant number of students, staff, and families to infection. It’s important not to underestimate Covid-19 transmission in schools. Several overseas studies of school outbreaks have used genome sequencing methods to demonstrate significant spread of Covid-19 in school settings. These findings match on-the-ground experience worldwide, particularly with Omicron outbreaks. The findings also align with our experience of other, more familiar infections that tend to spread rapidly through schools at the start of term and during the winter months.
“Another type of evidence that demonstrates in-school transmission has a more positive message, and that’s the strong evidence about the value of ventilation, air filtration, mask wearing, and other protections to stop the spread of Covid-19. If in-school transmission was negligible we wouldn’t see effects from these prevention measures, but overseas studies show that they can make a big difference. In NZ however, prevention measures for schools are still only partially in place and the vaccine rollout for 5-11 year-olds had only just started when the Omicron outbreak began, so protection for children has been patchy and inequitable.
“A whānau-centred approach aims to keep children safe in all settings, and provides options and protection for whānau. Some children may be better off with home learning when community transmission is high while other children might need to be in school. Resources and support should follow children so that they aren’t compelled to be in school during a major infectious disease outbreak.
“NZ families face a difficult winter with Covid continuing to circulate and other infections returning through the borders. But we should be optimistic because we do know how to control these infections. Key actions over the next 1-2 months could include:
- Schools providing clear information for caregivers about progress of the Omicron outbreak, with flexible arrangements in place that enable whānau to choose to keep children at home when local case numbers are high.
- Government importing and distributing respirator masks for children and school staff and encouraging all children in younger school years to wear high-quality masks if they’re comfortable doing so. Respirator masks protect against Covid-19 infection and a range of other infections that circulate in schools, and children report that they’re more comfortable than cloth and surgical masks.
- Keeping windows open is not going to be practical in all classrooms as the weather becomes cooler. A good short-term solution to provide air filtration in classrooms would be for Government to import and distribute materials for making Corsi-Rosenthal boxes. These boxes (essentially cubes made with filters and a fan) are effective at cleaning the air, and the boxes can be built as community projects.
- There needs to be a well-resourced Māori- and Pasifika-led approach to vaccination against Covid-19 and other childhood infections, including influenza, to improve vaccination coverage before the winter season.
- Paid sick leave is a key public health protection because it enables caregivers to stay at home if they or their children are unwell.”
No conflict of interest declared.
Dr Polly Atatoa Carr, Associate Professor, Te Ngira Institute for Population Research (formerly NIDEA), University of Waikato, and Public Health Physician, Child Health, Waikato District Health Board, comments:
“As seen internationally at the beginning of the Omicron wave, cases of COVID in children have risen markedly in Aotearoa New Zealand. The arrival of Omicron to our shores coincided with the reopening of our schools and learning centres for the beginning of the school year. Rapid increases in children and young people testing positive has meant that schools have needed to modify teaching programmes, cohort school years or classes for home learning on days of the week, and in some cases temporarily close.
“This is not particularly surprising given what we know about Omicron’s speed of transmission, the way Omicron cases in general have rapidly surged in our country, as well as our age-specific vaccination rates, particularly for those under the age of 12 years who are only just becoming eligible for their second dose. Further, we know that other preventative measures for COVID transmission, such as effective mask use, physical distancing, hand and cough hygiene etc, are more difficult to achieve in childhood. Transmission within families is also common currently, with changes in hours and teaching or learning strategies required in early childhood centres, schools and other educational institutions because of COVID in staff, and family isolation requirements.
“Our families, communities and learning institutes are doing an amazing job of coping with the ongoing burden from this pandemic, and an incredible job of wrapping support around each other.
“It is important, however, to note that while the rapid rise in cases in children is not particularly surprising, the burden faced by families and schools is real, and is not felt equally. Schools are not equally resourced. Families are not equally resourced, nor are all families equally able to cope with the challenges of home isolation. Those who need more support are more likely to be attending schools and learning centres that are also less resourced. These families are also likely to be at a greater risk of important consequences – such as job loss, income loss, hardship and stress as they struggle to cope with the juggle of: caring and providing for their children and young people; protecting those most vulnerable to severe COVID disease that may well be in their household; supporting the daily needs of their families and wider communities; and generally getting through life at this time. Some of these consequences will be long-lasting and will only exacerbate the existing and unacceptable inequities in wellbeing outcomes that we face.
“Necessary policy responses to this situation include the supports at the school level now arriving, such as ready (and equitable) access to Rapid Antigen Tests. However, policies that support parents, families and communities are also critical so that the results of those tests can be managed. These include job protection, extended paid sick leave, wage subsidies and hardship grants that do not increase debt levels, and the equitable and meaningful distribution of resources and decision-making to our community organisations that are making the real difference.”
No conflict of interest.
Dr Julie Bennett, Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:
To what extent are NZ children affected in the Omicron outbreak so far?
“Of those infected in this outbreak to date, 31% are children 19 years and under (but case numbers are not very reliable as there is probably major under-reporting of cases in children – who may often have no symptoms or very mild symptoms). Of all cases hospitalised, 12% of these cases have been children (<20 years). However, some emergency departments are reporting that even higher proportions of child attendees are infected with Covid-19.”
What is known about the role of schools in driving transmission?
“Worldwide, the arrival of Omicron, which is more transmissible than Delta, has seen an explosion in Covid-19 cases in children. Children are the last group to be vaccinated and some may be too young to wear a mask. This is an area where there is inadequate information in the New Zealand setting – surveillance systems to track school absenteeism by specific sentinel groups (such as children of healthcare workers) are needed to collect information on who in a household developed symptoms first (along with other risk factor information).”
How have recent changes to testing and contact tracing affected spread in schools?
“Without contact tracing within schools, it is likely that children who have unknowingly come into contact with a person who is Covid-19 positive are attending school and may unknowingly be infectious.
What impact is the new RAT access likely to have?
“Ensuring easy access to RAT tests will likely mean that more people undertake the test if they are feeling unwell. In schools that haven’t reported many cases, the use of these tests may help to delay the spread. However, given how much infection is occurring in schools, it’s hard to say what impact they may have at this stage.
What does Covid spread in schools mean for health inequities, and for longer-term consequences?
“Longer-term effects of Covid-19 in children include multisystem inflammatory syndrome in children (MIS-C), long Covid and potential increases in known chronic conditions. Please find more information in our recent Public Health Expert blog.
What do NZ schools’ responses to Covid-19 transmission look like?
“Schools appear to be responding individually to the needs of their communities. Some schools have implemented learning from home (hybrid learning) for those children who are either isolating or who wish to stay away while Covid-19 cases numbers are high. Other schools are conducting face-to-face learning with some schools rostering children to come on certain days. Some schools have more than half their staff and students away, but are not offering online learning.”
What policies or actions can help mitigate risk in schools?
“Until more is known about the long-term effects of Covid-19 infection in children we should try to minimise widespread Covid-19 infection in children. Online learning in schools and children working from home should be supported. Parents and caregivers who can care for their pre-school children at home should be actively encouraged to do so, especially for children under the age of one. It is acknowledged this may not be possible for some parents. For children who continue to attend ECE centres, playing and learning should be outdoors as much as possible.
“Schools and ECE centres should bring outdoor air in as much as possible by opening windows to get across-room airflow, and turn heaters on if needed to maintain warmth. If good ventilation is not possible then air purifiers (cleaners) need to be used. Teachers and students (appropriate age-groups) should wear good quality masks. Vaccination for teachers/staff and students in the appropriate age-group is important.”
No conflict of interest.