COVID-19 and the school response: Looking back to learn what we can do better

Image credit - GCISOn 9 March 2020, Minister of Basic Education Dr Angie Motshekga stated in a media briefing that schools should not make their own decisions in response to concerns about learners or staff with possible coronavirus, or schools closures. She noted that the Department of Basic Education (DBE)’s actions should be led by the Department of Health when managing the impending crisis.[1] At the time, South Africa (SA) had already had a 6-week head start to prepare an adequate public health response to the coronavirus. During the lead-up to the first report of an individual confirmed with COVID-19 on 5 March 2020, the Minister of Health informed the SA public that the country was well prepared to manage the threat. In support of his statements, the National Institute for Communicable Diseases (NICD) was exemplary in establishing laboratory test kits and providing up-to-date information to healthcare workers and the population at large, while the National Department of Health (NDoH) prepared designated hospitals to manage the anticipated caseload. However, we would argue that the response with regard to schools was woefully lacking. The absence of visible leadership by the NDoH is sadly reflective of our country’s ongoing focus on curative care rather than being inclusive of prevention and health promotion, the key tenets of primary healthcare and a health systems-wide approach.

Schools provide an excellent opportunity to reach children and adolescents from all socioeconomic backgrounds, and school health services constitute a promising platform to improve health equity by increasing coverage of needed health services in the most disadvantaged communities.[2] However, the COVID-19 pandemic has raised very difficult questions about how to place the health of our children at the centre of our response, and what kind of school health system will best protect children and their families in the context of community spread.

Drawing on lessons learnt from the 2013/14 Ebola outbreak, a resilient health system is one with the capacity to prepare for and respond to emergencies such as disease outbreaks, maintain core functions during emergencies, and learn from the emergency and reorganise as appropriate.[3] One of the essential features of a resilient health system is integration, where diverse actors from inside and outside the health sector, from government and non-government organisations and civil society, work together in a co-ordinated manner with a designated focal point for such co-ordination.[3,4] Integration is best achieved with pre-existing policies and co-operative agreements.[3] The Integrated School Health Policy, outlined in the National Health Insurance White Paper,[5] conceptualises SA’s school health system as embodying an intersectoral approach, with close collaboration between the departments of Basic Education, Health, and Social Development.

The COVID-19 pandemic has foregrounded the importance of intersectoral collaboration when developing a response for the education sector. No national or provincial guidelines, protocols, or instructions on how to immediately manage a suspected case or contact in the school environment – regardless of the nature of the communicable disease – were available prior to 11 March 2020, when the NICD published guidelines for schools, after several schools had already been affected and closed due to so-called ‘viral contamination’ and ‘deep cleaning’. Public health principles dictate that there should be a systemic and co-ordinated response to anticipating, recognising, evaluating and controlling a health threat. In an uncertain environment, having a protocol prepared in advance would have provided schools with the confidence that they had carried out their duty of care to an ill child as effectively as possible, while simultaneously protecting the health of others in their care and those coming onto their school grounds.

Read the complete Editorial on the South African Medical Journal website.