Schools and Covid: the compromises to be made to avoid a third wave

In the JDD dated January 3, 2021, Professor Jérôme Salomon, Director General of Health, expressed his fears about the start of the school year. “Children come back from different places, in France or abroad, it can reshuffle the maps of the epidemiological situation”, he explains, while evoking the suspicion of a greater contagiousness of english variants and South African of SARS-CoV-2.

The next day, in the France Info columns, Pr Robert Cohen, pediatrician infectious disease specialist at the intercommunal hospital of Créteil and president of the National Pediatric Council, affirms that the beginning of the year, after the school holidays, is the right time to resume school and considers that there is no need to review the health protocols set up in schools.

Same story on the side of Jean Castex on January 7 facing several unions of teachers of first and second degree as well as the same evening during his press conference: no closure of schools while the English variant has already won France, nor strengthening of health measures. A position endorsed the same evening by Olivier Véran on BFMTV, considering that there is no reason to close school canteens.

Yet teachers, parents and associations (like Forgotten school), as well as many doctors and scientists are calling for strong measures, recognition of the role played by children in the spread of the virus and denounce a wait-and-see policy of the government.

Should we be alarmed today about the maintenance of a health status quo in schools? Should we consider closing schools today? What solutions are presented to us in order to ensure, despite everything, pedagogical continuity and the necessary socialization of children and adolescents?

To answer these questions, we must understand the situation we are in today by taking into account what the last ten months, as well as the situation in England and Ireland, have been able to teach us about SARS-CoV-2. and Covid-19.

The role of neglected children

A number of studies published to date show that the role of children has likely been underestimated, if not overlooked. Testing children more systematically or measuring their antibodies, they tend to highlight the fact that children are at least as infected as adults with SARS-CoV-2. Children also have a viral load as high as that of adults. Therefore, there is no reason that they are less contagious and no data points in this direction.

By analogy with influenza, where 50% of those affected are under 18 and are notable vectors of the virus, the hypothesis that children participate in the transmission of SARS-CoV-2 is more than plausible. The hypothesis that this transmission is favored by the school is reinforced, as children spend several hours every day in closed, poorly ventilated, crowded and very promiscuous places, with difficult application of barrier gestures.

On the other hand, we know that the vast majority of children develop forms of Covid-19 less serious than adults, with few complications and few hospitalizations and very few deaths. It is precisely because the youngest have fewer severe forms and were only rarely hospitalized, that they were less tested at the start of the epidemic while PCR tests were rare and carried out mainly in hospitals. Even today, relatively little is tested on children. Indeed, the nasopharyngeal test is not easy to perform in young children or it is performed imperfectly and gives rise to false negatives. As such, the strengthening testing and the epidemiological surveillance announced by Jean Castex on January 7 will provide, if they are implemented, interesting data, failing, probably, to be useful to contain the epidemic alone.

The mutation of SARS-CoV-2 in England and the situation in Ireland initially led to believe that the new variant was more transmissible by children than by adults. However, it is simply more contagious. The explanation considered today is that if there was, between September and today, an increased transmission among children, it is because the confinement modalities decreed to keep schools open: the youngest was among the only social vectors remaining in a society of adults who are massively confined and working from home.

In short, the fact of having left open the schools constituted a real hole in the racket of the strategies of containment and it is undoubtedly at least one of the factors which explains the third wave which England cruelly faces and Ireland, with an alarming epidemiological situation.

The English variant was once thought to cause more severe forms in children. It appears that this is not the case, as evidenced by a press release from Royal college of paediatrics and child health published on January 2. If more children are sick, there are proportionately no more serious forms in pediatrics.

In a college in Bron, near Lyon, the 1^is September 2020. | Jeff Pachoud / AFP

Avoid a third wave

Today in France, the situation is very unstable with between 15,000 and 20,000 new cases per day, a reproduction rate that exceeds widely 1 for eight days and 50% of intensive care beds occupied by patients Covid+. This situation seems to worsen with the arrival of the English variant. At the same time, we are starting a vaccination campaign on an unprecedented scale, which mobilizes many members of the healthcare staff. Will it be possible to run this campaign properly if we have to face a third wave like in Britain?

A certain number of levers (curfews, closure of bars and restaurants, theaters, museums, cinemas, sports halls, etc.) have already been activated in an attempt to prevent this third wave. But, we fear that the start of the school year will sharply climb the curve. Indeed, if we could have feared that the mixing linked to the end-of-year celebrations would increase the number of cases, the holidays were also and above all a time when children were not placed in high-risk situations. transmission such as the classroom (too small, poorly ventilated, etc.) and the canteen, where children obviously eat and talk without masks and without easy respect for physical distance.

The past experience of seasonal flu has indeed shown us that the winter school vacation periods represented a powerful brake on influenza epidemics with a decrease in cases and – an unintuitive result – a drop in mortality among seniors. Of course, the coronavirus is another disease, but one which shares common points with the flu: it is a respiratory virus favored by the cold season, which seems to be transmitted easily in young people, but cause complications and death almost exclusively in the elderly or those suffering from pre-existing comorbidities.

It should also be noted that this fall we observed an epidemic restart of Covid-19 approximately 3-4 weeks after the end of the All Saints holidays throughout Europe, despite the re-containment measures.

Closing schools would be a particularly difficult measure, not only because education is a fundamental right and children and adolescents need educational continuity and socialization in situ, but also because, for the parents of the youngest, this raises the question of custody and therefore absenteeism of half of the workforce concerned. The experience of the first confinement has clearly shown that this problem also arises for parents who telework.

In this context of tension, not reopening schools after the Christmas holidays would have been a key health measure to prevent the risk of a rebound in January. Contrary to what Professor Cohen may have said, this would have been the right time. Indeed, limiting transmission in schools could have made it possible to slow down the epidemic restart favored by the development of the English variant on our soil, but also because cold temperatures, humidity and associated behaviors are more conducive to the contagion of children. respiratory viruses.

In addition, an extension of the winter holidays could have enabled schools to equip themselves with adequate ventilation systems or air purifiers and make arrangements capable of restricting transmission, not only by droplets but also by aerosols. Collective On the side of science, made up of doctors and scientists, has thus produced a number of supports to help schools face the challenges posed by the pandemic.

Possible solutions

A solution to consider so that the closure of schools weighs at least on children and their parents would be to lengthen the winter holidays by giving up part of the summer holidays, a period less conducive to viral spread, and where, it is hoped, the vaccination campaign will have started to bear fruit. In fact, by vaccinating the elderly, we can hope in the medium term to reduce congestion in hospitals and excess mortality among seniors who, let us remember, are the main reasons for the strong confinement measures and the closure of schools.

The fact remains that such rearrangements of school calendars cannot be considered without a global consultation of all the stakeholders (professional teachers ‘organizations, parents’ associations, etc.). Indeed, as evidenced by Philippe Meirieu, specialist in the sciences of education and pedagogy, interviewed by us: “One of the problems beyond the pandemic itself is that the management of the school system has been chaotic and has broken a form of trust between the faculty and the ministry.”

If he says he is not hostile to our proposals, he thinks that they should be the subject of a global and long-term reflection. He invites us not to wait until the last moment to make short-term, sometimes untenable and often contradictory announcements. «Today teachers feel weary, despised and forgotten, he says. Whatever the decision, communication must be reestablished. ”

After concerted reflection, compromises could be found with mixed distance / face-to-face teaching methods. “We were very numerous, from April 2020, to say that it was necessary to prepare an intelligent mixed formula for schools, colleges and high schools. I think we should have re-entered this model to limit the risk of contagion. This was not done when we knew there was a risk of a second wave, regrets Philippe Meirieux. If distance education is not worth face-to-face education, this mixed system, prepared upstream, could have been implemented considering that the 2020-2021 school year was going to be special. “

Today, the management of the health crisis seen from the side of the Ministry of National Education seems very little aware of the risks reassessed in the light of the new epidemiological situation in Europe and of a necessary prevention strategy based on consultation.

We dedicate this first article together at the memory of Jean-Yves Nau. His famous “See you tomorrow” we miss.