A parent confided in me, “Doctor, my child is behaving terribly weird and has been temperamental since the MCO started. I think he misses his friends.”
Another adds, “My teenage son is so moody these days. He is so fed up being cooped up at home.”
A third parent confesses, “Doc, I have three kids in three different classes, and I don’t have laptops for each of them. I have failed as a parent!”
Another concerned with her child’s deteriorating academic performance said, “My child is not getting optimal learning. Not all teachers are conducting proper online classes. Many just send WhatsApp questions and don’t even give any feedback on my kid’s answers.”
An angry father said, “Doc, I don’t trust whatever the government or the Ministry of Education (MOE) is telling me anymore!”
Ask any GP, family physician or paediatrician, and they would somewhat concur that these are daily conversations with the parents who visit our clinic for their children’s regular check-ups.
Malaysia, like other countries, is in the midst of a global educational crisis. The Covid-19 pandemic has put a billion children out of school.
For about 400 million children with no access to free school meals, this means missing out on their only decent meal of the day. Children living in households with abusive family members have now lost their safe havens provided by their teachers and friends at school.
Schools are an integral component of the local communities. Reopening schools and keeping them open is one of our greatest challenges as advocates of child education, health and welfare.
Clinical studies have shown a strong correlation between the frequency of Covid-19 outbreaks in schools and the incidences of outbreaks in the community.
If infection in the community is optimally suppressed, there will be a minimal number of cases among teachers and pupils.
But if there is an upsurge in community cases, as what is happening now, with sporadic, unlinked and widespread community transmission, it rapidly spills over into the schools and it becomes difficult to keep them open.
Therefore, it is vital to stop the transmission of the coronavirus within the community in order to prevent the spread of Covid-19 in the schools.
The school clusters comprise 5.5 per cent of the total clusters, but this is rapidly increasing.
Studies show that two-thirds of coronavirus transmission in schools occur between teachers and from teacher to students.
Teachers must therefore be exemplary, cautious, and not mingle freely in the staff room, which should by now have properly spaced cubicles to ensure physical distancing.
To stem the spread of Covid-19, all schools must adopt mitigation measures and SOPs as mandated by the Ministry of Education and advocated by the members of the Malaysia Paediatric Association.
The latter provided specific ideas for improvements on the ministry’s SOPs, encouraging the three Ws (Wash hands, Wear mask and Warn), and how to avoid the three Cs (Close conversation, Confined spaces, Crowded places) for students, teachers and administrative staff.
Apart from encouraging outdoor learning (indoor transmission is 18 times higher than outdoors), ventilating classrooms, etc., one other pivotal intervention is the practice of and strict adherence to class bubbles.
These bubbles, representing staff and students, limit mixing with other classes and age groups. These are best practices to help reduce sporadic transmission of the virus by keeping the same children and the same staff together.
The formation of these small class bubbles will also facilitate the management of a positive Covid-19 case, which would involve the isolation of the index case and the testing and quarantine of the affected class.
This strategy will not impact other classes or the whole school, which can operate as usual.
For the affected class, alternative teaching methods should be initiated, until the class is cleared to join normal face-to-face teaching in the school.
In this respect, clear and detailed written instructions should be provided to parents on what to do when their kids are exposed. A hotline can be implemented for parents to contact the school for further clarification and advice.
If a child in the class only had minimal exposure, remained asymptomatic and tested negative, his siblings should be allowed to attend schooling, and his parents should not be quarantined either.
Pre-emptive closure of schools should only be a last resort. And these should only be undertaken when the baseline community transmission exceeds a threshold incidence, as pre-determined by public health experts, fully cognisant of the burden and impact of viral transmission within the community.
The “red zone” concept is an idea plucked from the air by the Ministry of Health (MOH) and is not founded on sound incidence and prevailing data.
Data science, artificial intelligence and machine learning incorporated within available digital apps are more evidence based and reliable in this aspect.
The UK National Health Service’s Covid-19 app has played an invaluable role in “identifying areas at greater risk of a growth in cases and/or where restrictions on social and economic activity are successfully helping bring infections under control.”
The FTTIS Rapid Response in the community should be enhanced. A zero Covid-19 modus operandi targeted at maximum suppression of the virus is the best approach to prevent the virus from ever getting into schools, thus protecting our teachers and school children.
At the local level, empower autonomy to school heads to make local decisions deemed suitable for their school environment. The “one size fits all’ and “the Director-General of the MOH/MOE knows all” mindset needs a rethink.
The headmaster should be part of a committee comprising state education department officers and state health department clinicians. This committee should have proper communication so that school heads can get 24-hour advice and become competent at troubleshooting Covid-19 issues in their schools.
The school-based health team in charge of each district (ideally one in each heavily populated school) should be activated to monitor the situation on a regular basis and act promptly in concert with the school heads, when positive cases are detected.
Real time data should be shared with all schools so that the school authorities are up to date and can reassure parents that the school environment is safe.
Severe Covid-19 disease and associated mortalities continued to remain rare in children.
In the US, UK, Italy, Germany, Spain, France, and South Korea, Covid-19 deaths in children up until February 2021 was estimated at 0.17 per 100,000 population. They only comprised 0.48 per cent of all deaths.
The evidence indicates that children continue to be spared, mostly but not completely, the worst effects of the coronavirus.
However, the collateral damage to their learning, growth, psychological health, and social-development skills has been devastating.
Many of the gains we made from the MDG (Millennium Development Goals) and SDG (Sustainable Development Goals) have been either reversed or lost.
Prior to the pandemic, 400,000 households were living below the poverty line (RM2,280) in 2019. This translates into about 1.2 million affected children. And Covid-19 will push an additional two to three million into serious poverty.
UNICEF has reported that 37 per cent of B40 families in Kuala Lumpur are struggling to put food on the table.
The National Health and Morbidity Survey 2019 showed that 21.8 per cent of our children are stunted and many attend school with no or only irregular breakfasts.
The pandemic will most certainly worsen childhood malnutrition, with long-term consequences for growth and neuro-development. We must ensure food security for these children through an effective social safety net.
On the other hand, movement control orders (MCO) that inevitably result in decreased physical activities have led to overweight and obese children.
A survey by the MOE of about 900,000 students revealed that 37 per cent of students do not have any appropriate devices. Only six to nine per cent of students own a personal computer.
Even if a household has a personal computer, many would have to share it with other family members for work or study. This would undoubtedly negatively impact e-learning and contribute to the regression of their learning abilities.
This digital divide must be immediately bridged. Devices and the internet must be made more accessible to poorer families. More strategically, keep schools open as much as possible
There is also a documented rise in domestic violence and child abuse during the MCO. Social services need to deal with this problem. Again, more importantly, schools opening presents a respite for these abused children.
The prolonged pandemic would inevitably have a negative impact on the mental health of our children. This may range from phobia and psychological syndromes, to Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD), often invisible to the casual eye.
Friendships at schools comprise the child’s natural social environment and is essential for their normal psychological development and wellbeing.
Children under 18 years old make up 29 per cent of the Malaysian population in 2018. This means that virtually all adult Malaysians must be immunised to attain herd immunity to protect our children who are presently not eligible for the vaccines.
This would seem a herculean undertaking, considering that 35 per cent of our adult population are either hesitant or refusing any from of immunisation.
To ensure our schools remain open and the education of our children are not interrupted, all teachers and school administrative staff should be prioritised in the upcoming Phase Two of the National Covid-19 Immunisation Programme (PICK).
In conclusion, if you take away school and all the essentials of child nurturing, then you will have a generation of children whose futures will forever be scarred.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
