APRIL 21 ― A parent confides in me, “Doctor, my child is behaving terribly weird and temperamental since the MCO. I think he misses his friends”

Another adds, “My teenager son is so moody la these days. He is so fed up being cooped up at home”

A third parent unashamedly confesses, “Doc, I have 3 kids in 3 different classes, and I don’t have enough 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 sent WhatsApp questions and don’t’ even give any feedback on my kid’s answers”

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An angry father raises his voice, “Doc, I don’t trust whatever the government or the Ministry of Education is telling me anymore”

Ask any GP, family physician or paediatrician and they would somewhat concur that these are daily conversations which we encounter with the parents who visit our clinic for their children’s regular check-up.

Malaysia like the rest of the world is in the midst of a global educational crisis. The Covid pandemic has put 1 billion children out of school. To about 400 million children, this means missing out on their only decent meal of the day, with no access to free school meals. Children living in abusive households have now lost their safe havens provided by their teachers and friends at school.

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Schools are an integral component of the local communities. Reopening schools and keeping them open is today one of our greatest challenges as advocates of child education, health and welfare.

A Form One student takes part in an online class near her mother’s food stall in Shah Alam amid movement control order January 20, 2021. — Picture by Yusof Mat Isa
A Form One student takes part in an online class near her mother’s food stall in Shah Alam amid movement control order January 20, 2021. — Picture by Yusof Mat Isa

Clinical studies have shown a strong correlation between the frequency of Covid outbreaks in schools and the incidence of Covid in the community. If Covid infection in the community is optimally suppressed, there will be minimal number of cases among the school teachers and pupils. But if there is an upsurge in the community cases, as is happening now, with sporadic, unlinked and widespread community transmission, it rapidly spills over into the schools and it becomes difficult to keep the schools open.

Therefore, it is vital to stop the transmission of the coronavirus in the community in order to prevent the spread of Covid into the schools.

The school clusters comprise 5.5 per cent of the total clusters, but this is rapidly increasing [1].

 Studies show that 2/3 of coronavirus transmission in schools occur between teachers and from teachers to pupils. Teachers must therefore be exemplary, cautious, and not huddle in the staff room, which should by now have cubicles to ensure physical distancing.

To stem the spread of Covid, all schools must adopt mitigation measures, SOPs, as mandated by the MOE and advocated by the members of the Malaysia Paediatric Association [2]. The latter gave specific improvements on the Ministry’s SOP to encourage the 3 Ws (Wash hands, Wear mask and Warn) and how to avoid the 3 Cs (Close conversation, Confined spaces, Crowded places) for the students, teachers and administrative staff.

Apart from encouraging outdoor learning (indoor Covid transmission is 18X higher than outdoors), ventilating classrooms etc, one other pivotal  intervention is the practice and strict adherence to class bubbles. [3]

These bubbles represent cohorts of staff and pupils to limit mixing with other classes and age groups. These are best school practices to help reduce sporadic transmission of the virus by keeping the same children and the same staff together.

Equally important, the formation of these small class bubbles will facilitate in the management of a positive Covid case, which would only involve the isolation of the index case and the testing and quarantine of the specific affected class. This strategy will not impact other classes or the whole school which can operate as usual. For the affected class, alternative teaching, namely online, should be commenced, until the class is cleared to join formal face to face teaching in the school.

In this respect, clear and detailed stepwise written instructions should be provided to parents on what to do when their kids are exposed. Preferably install a hotline for parents to contact the school for further clarification and advice.

If a child in the class had only minimal exposure, remained asymptomatic and tested negative, his other siblings at home should be allowed to attend schooling and 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 spread is excessive and exceeds a threshold incidence as pre-determined by Public Health experts, fully cognizant of the burden and impact of viral transmission within the community.

The “Red Zone” concept is an idea plucked from the air by the MoH and is not founded on sound incidence and prevalence Covid data. Data Science, Artificial Intelligence and Machine Learning incorporated within available digital apps are more evidence based and reliable in this aspect [4].

The UK’s NHS 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 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 “DG MoH/MoE knows all” mindset needs rethinking.

The headmaster is part of a committee/virtual team comprising State Education Department officers and State Health Department clinicians with seamless communication so that school heads could get 24 hours advice and become competent at trouble shooting Covid 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 Covid data should be shared with all schools so that the school authorities are up to date and can reassure parents that the school ambience is Safe@School just like other priority areas eg. Safe@Work, Safe@Prison, Safe@BazarRamadan etc.

Since the early reports from China, severe Covid-19 disease and associated mortalities continued to remain rare in children [5]. In the USA, UK, Italy, Germany, Spain, France, and South Korea, Covid deaths in children up till February 2021 was estimated at 0.17 per 100,000 population. It only comprised 0.48 per cent of all-cause deaths. The evidence indicates that children continue to be spared, mostly but not completely, the worst outcomes of the coronavirus.

Notwithstanding, the collateral damage to their learning, growth, psychological health, socio-development etc. 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 Covid, 400,000 households were living below the poverty line (RM2280) in 2019. This translates into about 1.2 million affected children. And Covid will push an additional 2-3 million into serious poverty. [6]

Unicef reports that 37 per cent B40 families in Kuala Lumpur are struggling to put food on the table. [7].

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.

Covid will most certainly worsen childhood malnutrition with its 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, MCO with decreased physical activities have led to overweight and obese children

A survey by the Ministry of Education (MoE) of about 900,000 students revealed that 37 per cent of students do not have any appropriate devices. [8] Only 6 per cent to 9 per cent of students own a personal computer. Even if a household has a personal computer, many would have to share with other household members for work or study. This undoubtedly would negatively impact on e-learning and contribute to 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 a documented rise in domestic violence and child abuse during the MCOs. Social services need to be strengthened. Again, more importantly, schools opening presents a respite to these abused children.

The prolonged and fearful pandemic would inevitably have a negative impact on the mental health of our children. This may range from phobia and fear syndromes, to obsessive-compulsive disorders (OCD) to Post Traumatic Stress Disorders (PTSD), often invisible to the casual eye. Companionship and friendship at schools comprises 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 (2018) [9]. 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 Covid 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 2, Program Imunisasi Covid-19 Kebangsaan (PICK).

In conclusion, if you take away school and all the essentials of child nurturing away from them, then you have a generation of children whose future will forever be scarred.

* This is the personal opinion of the writer and does not necessarily represent the views of Malay Mail.