UAE COVID-19: Should you send your kids back to physical school? Here's the research

In the run-up to UAE schools reopening on 30 August 2020, parents across the emirates are divided over whether or not to opt for an in-person or distance mode of learning for the Autumn term.

While children were originally thought to be COVID 'superspreaders' - as they typically are with other respiratory illnesses -  it has been puzzling for scientists to realise that kids don't seem to be major transmitters of the coronavirus that causes COVID-19 at all.

Now that both the Abu Dhabi and Dubai educational bodies have announced that schools are requried to give the choice of either remote or physical learning to all parents, it's up to the families themselves to weigh up the risks and decide which avenue they prefer.

But, as scientists and public health authorities across the world are still scrambling to determine the role of young people in spreading the pathogen and how best to mitigate that threat, it's a choice that's easier said than done for many.

"Many of the parents I see are very worried about their kids catching the infection," says Dr Deepti Chaturvedi, specialist in paediatrics at Burjeel Hospital Abu Dhabi. "But children's psychological health is also very important. Kids have been sitting at the home for the last 6-8 months. They have been inside, not mixing with their peer group, with most learning being done online. We have seen so many cases where there have been side effects from the e-learning process because of the excessive screen time."

We look at the evidence currently available on COVID-19 and kids, and weigh up what that means for UAE parents and children on the upcoming return to school.

1. To what extent are kids getting infected with the virus?

Estimates by midyear indicated that only 2% to 5% of individuals with laboratory-confirmed COVID-19 were under 18 years old, reports the Washington Post. One survey in the US found infections among children grew 40% in the last half of July, bringing the total number to 8.8% of all US cases. That's all well below that age group's share of the global population, which hovers around 30%. Compared to adults, children with COVID-19 typically have milder symptoms that are predominantly limited to the nose, throat and upper airway, and they rarely require hospitalisation.

2. Is the risk of COVID-19 spread evenly across children?

Perhaps not. Children younger than 10 are significantly less susceptible to the virus than teenagers and adults, according to research by scientists at the Harvard T.H. Chan School of Public Health in Boston and the University of St Andrews in Scotland that was released ahead of peer review and publication in July. Susceptibility for children older than 10 was similar to adults, apart from those over 60 years, who are at greater risk, they said. The findings are supported by a study published in June that used antibody tests to survey 2,766 people in Geneva. It found teenagers were almost as likely to have been infected by the virus as adults age 20 to 49, while children age 5 to 9 trailed well behind.

3. Why might younger kids be less susceptible?

There are several theories. Scientists have posited that covid-19 might be sparing children because they are less exposed to the virus, with school closures and other distancing measures largely isolating them, according to a report by The Washington Post. It's possible children mount a more robust initial immune response to the virus, giving the body a better shot at fending it off (and avoiding some complications adults get). It's also been suggested that the receptor the virus uses to invade human cells is less mature in children, making it harder for it to cause an infection. Younger people are less commonly afflicted by hypertension, type-2 diabetes and other chronic conditions known to increase the risk of severe illness from covid-19. A low infection rate and mild symptoms among children were also seen during earlier outbreaks of two other novel coronaviruses, one in 2002-2003 that causes severe acute respiratory syndrome (SARS) and another starting in 2012 that causes Middle East respiratory syndrome (MERS).

4. Do kids spread the virus?

It's not yet clear, but it may depend on if they're sick. Children younger than 5 with "mild-to-moderate" covid-19 have higher concentrations of the virus in their upper airway than older children and adults, doctors in Chicago reported in July. This could make them more infectious. However, another study published in Nature found the vast majority of infected kids in this age group don't have symptoms, which reduces their likelihood of transmitting the virus. In another, much-cited study of 5,706 coronavirus patients and their contacts in South Korea, researchers concluded that children younger than 10 spread the virus within a household at the lowest rate, but those age 10 to 19 were more likely to spread it than even adults. The study had limitations. As with similar studies, the researchers first identified an infected person and then tested that person's contacts, which means they can't be certain who started the chain. Plus, the study was conducted while schools were mostly closed. In the US, school closure was associated with a 62% drop in covid-19 cases and 58% decline in deaths, researchers in Cincinnati reported in July. They acknowledged that the trends were largest in states with a low cumulative incidence of covid-19 at the time schools were shut, and that it's possible some of the reduction was due to other measures.

5. What's happened where schools have already reopened?

The evidence is preliminary and mixed. Denmark and Norway reopened schools in April and avoided subsequent outbreaks. Health specialists connect their success both to mitigation strategies including smaller classes and increased hand washing, and to the fact that overall cases were low at the time. Germany brought older students back to schools in small groups in early May when overall cases were moderately high and saw increased transmission among students, though not school staff. In Israel, schools were fully reopened without restrictions on May 17. Ten days later, a major outbreak occurred in a high school, followed by a significant wave of infections in the general population, prompting the government to shut down parts of the economy again.

6. How sick do children get from COVID-19?

Scientists at the London School of Hygiene & Tropical Medicine in June found that clinical symptoms manifest in 21% of infections in 10- to 19-year-olds, rising to 69% in people older than 70. Death is extremely rare in children, although it can occur in those who are already very sick with cancer or other serious conditions. An uncommon but serious blood disorder has been associated with SARS-CoV-2, as the virus is called. Known as paediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), it's a potentially lethal condition, similar to Kawasaki disease. It occurs at a rate of about two per 100,000 people younger than 21 years - much less than the 322 per 100,000 in which coronavirus infection is diagnosed in that age group.

7. What will UAE schools do if there is a COVID-19 outbreak on the premises?

The KHDA has released very clear guidelines on the protocol that must be followed if a child or staff member starts to show signs of COVID-19 while at school. All schools are required to have an isolation room, where any child or staff member exhibiting symptoms will be sent while awaiting transport to a hospital or other venue where they can be tested.

“If a positive result is detected in one of our schools, the school will immediately implement our contact tracing process, which involves identifying any students or staff members who have been in close contact with the ‘positive case’," says Paul Slater, vice president of Operations and Health, Safety and Environment at GEMS Education.

Close contact is defined by the KHDA as ‘anyone who spent more than 15 minutes in a proximity of two metres with the positive case, from the day of symptoms onset or the day of the positive PCR test’. "Any students or staff members who are subsequently identified within this group will be required to undergo 14 days’ self-quarantine. In addition, immediate and thorough cleaning and sanitising of the school will be conducted. All actions taken will also be clearly communicated to parents.”

8. What does the research mean for whether parents should choose physical or online school this term?

There is no simple answer. Most UAE parents are in the fortunate position of being able to choose between either in-person or distance-learning for the upcoming academic term, with both Dubai and Abu Dhabi schools required by their educational bodies to offer a 100% distance-learning programme, in addition to in-person schooling. While this undoutedly complicates things for schools, it does mean that parents who are worried about the virus can keep their kids at home all term, or even wait and see how the return to school pans out in terms of future outbreaks.

However, there are two major beneficial factors at work now, which were not the case when schools were initially closed back in March:

Firstly, with a lot more research into the nature of how COVID-19 spreads now available, when schools open on August 30 it will be with an artillery of evidence-backed precautionary measures in place, such as mandatory mask-wearing, social distancing and frequent sanitisation. This will make for a slightly strange, but much safer, school environment.

And secondly, having learnt on-the-job from a term's worth of surprise distance learning, schools will be much better placed to provide the most effective form of home learning to their students, based on their previous experience. Both of these factors reduce the risk of either option, meaning that parents are left with a less high stakes decision than it would have been if they'd had to make it in the summer term.

Parents need to take a balanced approach, but should not be unduly worried by the propect of in-person schooling, says Dr Deepti Chaturvedi, specialist in paediatrics at Burjeel Hospital Abu Dhabi: "For children who don’t have any long-term issues, who are not immune-compromised and who don’t have any liability with their immune system, parents should not be too scared about sending the kids back to school - so long as they can inculcate in their children the basics of hygiene, hand washing, and social-distancing habits."

Parents should also consider the right balance for their children's mental health when making their decision, says Dr Chaturvedi: "Kids need their peer group and an environment in which they can learn to think out of the box instead of only sitting in front of the box. As long as parents, schools and teachers can make the kids follow the rules we are in a safe learning system."

Ultimately, though, there is no right or wrong, says Dr Chaturvedi: "Each parent has to decide what's right for each individual child."