The dozens of passionate comments left on the AusDoc website as to whether schools should open shortly reveal how difficult it is to make wise decisions in an emotionally fraught setting (as when the health of our children is at stake) without a solid base of facts.
It
is a terribly complicated matter, unlikely to be
resolved painlessly.
Children,
parents, teachers, and workplaces will all be affected one way
or another. What might be workable in one locality may
not work in another – making a ‘one-size-fits-all’
solution an awkward fit.
We
know that COVID-19 thrives in areas of low-socioeconomic
privilege, and we should attend especially to the needs
of schools in poorer areas when considering closing
them.
It
found 155 deaths occurred among men in the least privileged quintile –
compared with 43 among the most privileged. And 156 deaths occurred
among least privileged women – compared with 40 among the most privileged.1
So, I
wonder if it might be possible to have different policies with regard
to school opening for different localities depending on
socioeconomic status?
But
hang on, let’s suppose we did make school closure or opening a local
decision, what would follow?
The decisions,
if taken locally, would be fearsomely difficult to administer because of their
sheer variety. They may overload the bureaucratic system and we have quite
enough confusion as it is.
The
US has been criticised for taking this local approach with the choice to
open left to 14,000 or so school districts.
This had “splintered
the conversation about school closures into thousands of noisy arguments”,
according to The Economist in its 15 January edition.2
If
we closed schools in line with the death
statistics just quoted, then those schools in poorer suburbs would be shut
while those in the more affluent suburbs would be open.
Read
more:
- Dr
Nick Coatsworth takes swipe at prominent GP
- RACP
joins dozens of doctors in push for schools to stay open
- GPs
fear shortfall of kids' COVID-19 vaccines
These
latter schools may bear the hallmarks of privilege in other
ways too including better building stock, less
crowding, more health-literate parents, high rates of
vaccination and with easy access to healthcare.
In
the poorer areas, if schools remained shut, who would look after the
children and enable home learning? Probably parents or other
carers who may really need to work to maintain the
family income.
The
educational and social development impacts of school closures on the children
would be greatest in the areas least able to compensate. Damned if you do
and damned if you don’t.
An international declaration advocating
an approach to COVID-19 that favours herd immunity in concert
with protection
to the most vulnerable and signed in October
2020 by 916,000 epidemiologists and infectious disease
specialists, has strong words about lockdowns.3
“Keeping
students out of school is a grave injustice,” the Great
Barrington Declaration says.
That
was before Omicron.
I’m
afraid you run into some hard and uncomfortable
truths here relating to health and social inequality.
The significance of
inequalities – which we always knew were reflected in health and disease
differences – is revealed starkly in the death data related
to COVID-19 just quoted. The well-known association
of poverty with illness has been
amplified greatly.
It’s
as though the virus has stimulated a ‘PCR’ or ‘polymerase chain
reaction’ on a substrate of social gradients in health and disease.
For
the moment though – tough as it may seem to say
it – we may be left to ‘muddle through’ with
regard to school openings.
If
schools do open, so should the windows. If open spaces, indoor and
outdoor, are available, use them.
If
the kids can tolerate masks, then they should be encouraged to wear
them (I have a profoundly intellectually impaired grandson and he will
never wear one).
Highly
effective masks for teachers and administrative staff should be readily
available.
If
vaccines are available, let’s jab.
COVID-19 is
not over, and we should be prepared for more mutations
and more anguish.
In the
process of that preparation, let’s refresh our thinking
about the principles of good health promotion as the basis for
effective prevention.
In
1974, Marc
Lalonde, the then Canadian Minister of National Health and
Welfare, commissioned a report called A New Perspective on the
Health of Canadians.4 It received international
acclaim. It aimed to answer Lalonde’s question about why,
with all the money Canadians spent on health,
things weren’t better.
At
the time a vast amount of that money went into the hospital system, but as
the report went on to show, many of the health problems
Canadians experienced where potentially preventable if action
was taken on the determinants of health way beyond medical care
and hospitals.
It
offered the Health Field Concept as a basis. Take for example
road deaths: lifestyle, environment
and healthcare organisations contribute to traffic deaths in the
proportions of something like 75%, 20% and 5%
respectively, the report said. Yet this is not how Canadians
(and us) had been splitting the money.
If
we adopt this approach to COVID-19, we will not only ensure
that our hospitals can cope, but do more about the impact
of poor lifestyle and environment on seriously
affected communities.
Schools in less
privileged areas are more likely to be of poorer construction. Ventilation may
be inadequate.
The
prevalence of Omicron may be higher in the community and vaccination
rates in the community lower.
The
communities have less reserve to cope with home schooling – think home
computers and quiet spaces for students. These are all things that we can
do something about!
We
need short-term solutions such as these to the vexed question of
school opening, allowing space for different opinions because we don’t have the
data to be definitive. But it is surely better to do something
beneficial than nothing.
COVID-19 has
torn into the most vulnerable of our communities in a shocking
manner.
We
need to think beyond the current pandemic to the widening gap in
health between the haves and have-nots in our society.
It
would be sad if we do not, as
Australians, take this opportunity to consider what kind
of humane society we want for our future in which we
can all flourish – and invest accordingly.
References:
2.
The Economist, 15 January 2022
3.
The
Great Barrington Declaration, October 2020
4.
A New
Perspective on the Health of Canadians, 1974
Published in the Medical Observer, 19 January 2022
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