By Dato' Dr Amar-Singh HSS / Dr Shyielathy Arumugam

With the COVID-19 pandemic expected to last for a number of years there will be a need at some point to consider opening our school and kindergartens.

Currently children form a small proportion of those who have tested positive in the pandemic. Although children get infected with COVID-19 and transmit the disease, the majority do very well or remain asymptomatic; severe illness and death are rare. Adolescents have a slightly higher risk of significant illness. The major worry for children is that they may transmit the virus to parents, grandparents and teachers who might have a more severe illness.

Recently however there has been concern with some young children infected with COVID-19 presenting with a 'Multisystem Inflammatory Syndrome in Children' (MIS-C) (Kawasaki-like disease), with some fatality. This is an uncommon disease that usually affects very young children with a 'vasculitis' (inflammation of blood vessels). The numbers of children with this inflammatory syndrome are still small. However it suggests that some young children may be vulnerable to COVID-19, thus this emphasizes the need to limit its spread in the community.

As we attempt to open schools and learn from the few countries that have done so, we must recognize that the key will be to try and create a bubble (a shield) in which students who go to school 'live in' so as to minimize infection spread. This 'bubble also means that if one group has COVID-19 infection only they are isolated and the rest of the school can probably continue. We need to continue to maintain our focus on stopping COVID-19 spread by safe physical distancing, avoid touching faces, cough etiquette, mask/face shield wearing, preventing crowding, limiting physical contact and talking, keeping hands clean at all times, keeping surfaces clean at all times.

This guide (SOP) aims to help offer ideas and initiatives that could be taken when we reopen schools. Teachers need to work very closely with parents and students; parents and children can play an important role. Students should be involved and provided a clear understanding of the situation. Younger students and those with learning disabilities may require reinforced training with a focus on visual tools. Support between schools will also be critical. Only when communities support, help each other and share resources can we move forward in this crisis.

The guide covers the areas to consider and offers suggestions for improving COVID-19 prevention. It looks at many aspects that involve teachers, supporting staff, students and the environment. The SOP is written to take into consideration the busy national-type school where classrooms are full with high student-to-teacher ratios (40 per class) and a two-session system (morning and afternoon sessions). Suggests are made on how to reduce class sizes into 15-20 'bubbles' – these students should have a color coded arm band to serve as a reminder not to mix with those who have a different color. There will be a need to use e-learning strategies to supplement limited school hours and maintain a daily learning environment. There are options offered as to whether students and teachers should wear masks or opt for face shields. Attention is also focused on the cramp teachers/staff room. Children who come from disadvantaged communities, and who depend on school meals for their basic nutrition, must not be forgotten.

Schools should consider a step-wise start-up of classes by staring with the older students to establish a routine before introducing the younger students. Students with special needs should be the last in the class start-up list as they need more time and consistent training to understand and adapt to the new routine. Teacher must model and supervise all safety measures to students.

The full COVID-19 Prevention in Schools Guide is available for download and use from this link.

Note that the information provided in this guideline does NOT take precedence over any guidelines from the Ministry of Education (MOE). Persons involved in writing these guidelines did so in their individual capacity and do not represent the organizations they work with.

Some of the changes suggested here may need to be implemented as long term measures that out-live the COVID-19 pandemic. In particular, it is important to design better schools with more classroom space, better ventilation and a green environment. The learning environment should be transformed to make self-directed learning a reality. Incorporating universal design for learning (UDL) is vital as this approach to teaching is inclusive and meets the needs of every student in a classroom. Greater use of and access to technology, especially for disadvantaged students, will be useful.

(Dato' Dr Amar-Singh HSS is Consultant Pediatrician; and Dr Shyielathy Arumugam is a Special Education Educator.)