Closing schools is the wrong response to COVID-9 threat, say infectious disease experts
The UK is closing its schools indefinitely, but Australian experts say this is a âknee-jerkâ response without medical or epidemiological justification.
In fact, an investigation in Sydney has concluded that children are more likely to catch COVID-19 in the home, from adults, than from each other.
David Isaacs, professor of paediatric infectious diseases from the Childrenâs Hospital at Westmead and Sydney University, told TMR that COVID-19âs behaviour was entirely different from influenzaâs when it came to the very young.
âWe know that there are a few children who have been infected [with SARS-CoV-2] within schools and they havenât passed it on to large numbers of other children in the school,â Professor Isaacs said.
âIf youâve got influenza and one child gets it, the whole class gets it. You can stop a nasty flu outbreak by closing schools. So that makes some sense.
âBut to say children might be spreading [COVID-19] and therefore we should close schools doesnât seem to me very sensible. The advisory panel is probably the top brains in Australia and theyâre saying, Steady on: there are knock-on effects from closing schools. Who do you think is going to look after the kids? Itâs going to be the grandparents.
âThen it disrupts everyoneâs working life and [has psychological effects] on the kids.
â[ABC presenter and former paediatrician] Norman Swanâs out there saying we should be closing the schools. That seems to me be a very knee-jerk sort of comment. Most spreading is occurring within homes.â
Professor Isaacs said the level of fear in the community was disproportionate to the threat, which was far less than that posed by diseases less than a century ago.
âAs an infectious disease physician, Iâm just throwing my hands up and saying, Hey, donât get so panicked about this. Itâs not going to be the end of civilisation as we know it.â
Thousands of doctors have signed various letters and petitions to the government demanding a more extreme response to the outbreak, calling for schools, gyms, pubs, bars, theatres, cinemas, places of worship and so on to be closed for three to four weeks.
But neither the RACGP nor the AMA has backed these calls, instead supporting the governmentâs measured approach.
âAt the moment weâd be following the advice weâve been given,â RACGP president Dr Harry Nespolon told the ABC yesterday, âwhich is that kids are at low risk and to keep the health system going we need as many people working as possible [and to minimise] the risk of staff being exposed and having to stay home in self-isolation for two weeks.
âSo at the moment from what we know, keeping the schools open seems to be the right thing in terms of medical capacity and, more importantly, keeping children safe.â
Professor Tania Sorrell, director of the Marie Bashir Institute for Infectious Diseases and Biosecurity, said in the same interview that if children do become infected, âtheyâre more likely to get it at home from adultsâ.
She cited the done by CHW and the National Centre for Immunisation Research that tested all the contacts of a few infected children in Sydney and found they had not spread the virus to their classmates.
âI completely understand the anxiety ⌠but I donât believe the data we have at the moment [shows] that will make the kids safer. If you look at the potential impact on older people who may have to look after them â in the US itâs estimated that up to 40% of children would have to be looked after by their grandparents.
âIn this country we estimate around 15% of the total workforce would have to stay home and an even higher percentage of healthcare workers. So we need to balance the risks and potential detriments, recognising that the elderly have a much higher mortality rate.â
The lack of severe COVID-19 illness in children â similar to the first SARS in 2002-03 â was observed early on but has not yet been satisfactorily explained.
âThe question that still not really resolved is whether [these coronaviruses] donât infect children so much, or whether they do infect children but they donât affect children so much,â Professor Isaacs said.
âFrom a scientific point of view, we havenât got a clear explanation.â
Some have speculated that ACE2 receptors, which the virus binds to in the upper and lower respiratory tract, are expressed less in children, but Professor Isaacs says there is no actual evidence for this.
âShowing that children do or donât express receptors has never been terribly successful,â he said.
The idea that children have stronger immune systems also falters when it comes to very young infants.
âWeâve had babies, newborn babies, infected with the virus â the mumâs had it at birth and the babies get infected â but they donât seem to have anything much in the way of symptoms. They donât get nasty pneumonia. And yet little babies are more vulnerable to infection than almost any other age in life. So if that was really the case you would expect the babies to get in trouble.â
Professor Isaacs said one possible factor in severe disease was an excessive immune response, or cytokine storm.
âTo get a really nasty pneumonia, you need a very vigorous host response, because your host response does use some damage in the process of trying to deal with the virus. Thatâs what we think happened in 1919 with pandemic flu, which tended to hit young adults and be very nasty in them.
âThatâs one possibility that doesnât really explain it all â why do the elderly get such bad mortality? Youâd have to say, the elderly canât cope with it at all and the virus goes spreading.
âWell, weâd expect that to happen in a one-year-old, for example. It doesnât.
âWeâve seen just three kids with COVID-19 infection. Two of them had a cold and one of them had nothing. No symptoms â it was just picked up because one of the family members had it.â
Professor Isaacs said there was probably some genetic component, noting that younger adults had been worse affected in some populations â Italy and Iran â than others. This still didnât explain why children everywhere were less affected.
He said part of the difficulty with COVID-19 was disease ascertainment, and that he was sure there was a large infected but asymptomatic population that was left out of the estimates of what proportion got worse illness.
The widely cited 80:20 ratio of mild to severe cases was probably ânonsenseâ.
âI think the 80:20 is the ones we diagnose,â he said. âBut smouldering underneath are a whole load of others. I think the real number is actually much more like 90:10 or 95:5.â
