Australia has introduced a ban on non-essential mass gatherings of 500 people or more to control the spread of Covid-19, but so far has not opted for mass closure of schools.
Several schools in New South Wales and Victoria with confirmed cases of coronavirus have temporarily shut, but chief medical officers have not advised wide-scale closure.
So why hasn’t closure been recommended and are there dissenting views about whether – and when – it will be necessary?
How has the government explained lack of school closures?
On Sunday, Scott Morrison said:
[On] the issue of wide-scale closure of schools, it might be anti-intuitive, but the advice is this could actually be a very negative thing in terms of impacting on how these curves operate.
That happens for two reasons. When you take children out of schools and put them back in the broader community, the ability for them to potentially engage with others increases that risk. And that’s the understanding we have …
The other issue is the disruption impact that can have and put at great risk the availability of critical workers such as nurses and doctors and others who are essential in the community because they would have to remain home and look after their children.
And so while it may seem counterintuitive, there is very good reason why you would not be moving to broadscale closures of schools that could actually make the situation worse, not better. And so the states and territories are not moving in that direction.
Does this position conform with medical advice?
Yes. The Australian Health Protection Principal Committee – composed of federal, state and territory – has advised at this stage that essential functions, including schools, universities, workplaces and public transport do not need to stop functioning.
In a statement, the Victorian chief health officer, Brett Sutton, has said that he “fully endorses” the committee’s advice “that pre-emptive school closures are not likely to be proportionate or effective as a public health intervention to prevent community transmission of Covid-19 at this time”.
There is currently limited information on the contribution of children to transmission of Covid-19. The WHO-China joint mission noted the primary role of household transmission and observed that children tended to be infected from adults.
Previous work suggests that the potential reduction in community transmission from pre-emptive school closures may be offset by the care arrangements that are in place for children who are not at school.
There is a particular risk associated with the fact that children may require care from vulnerable grandparents or may continue to associate (and transmit infection) outside of school settings.
Broadly the health advice on school closures from previous respiratory epidemics shows the health costs are often underestimated and the benefits overestimated.
This may be even more so in relation to Covid-19 as unlike influenza the impact on otherwise healthy children has been minimal to date.
Have others gone further in calling for school closures?
Some have suggested that preventing transmission in all settings, including schools, should be the priority.
The general practitioner and former AMA president, Kerryn Phelps, has said “within a very short time frame we’re going to have to look at the closure of schools and closure of universities for a couple of weeks in order to help with limitation of transmission”.
Anthony Albanese has noted that some private and independent schools have opted to close but has stopped short of calling for mass school closures.
“What I don’t want is the government to be too far behind here,” he told Sky News.
“I can’t see how [school closures] won’t happen at some stage. What we need, though, is for those decisions to be essentially recommended by the medical officers – if they say that is where it’s going to go, we need transparency.”
What do independent experts say?
Prof Jonathan Carapetis, a paediatrician and a leading expert on infectious diseases, told Guardian Australia the medical community’s view is “not that straightforward” but everyone agrees a “balanced discussion” rather than knee-jerk reaction is required.
The executive director of Telethon Kids Institute said the argument for school closures is to prevent transmission from child to child and back to their family.
“But the evidence that closing schools will have a significant impact on transmission of the pandemic is not that strong,” he said.
“Children don’t seem to get severely unwell, they either get a mild version or show no signs of illness, so the early data is that they are not significantly involved in transmission.”
School closure “is not the panacea some may think”, Carapetis said, citing the fact it could take 10-20% of people out of the workforce and put parents and grandparents at risk of a more severe health outcome.
Carapetis suggested that children in school are “easier to control” because they can be taught hand hygiene and measures like banning assemblies and school carnivals can reduce risks.
What about herd immunity?
Morrison has noted that the prospect of developing herd immunity has been raised in the UK.
Carapetis explained that one way to prevent transmission is to “increase the proportion of the population with some immunity to the disease”.
“Given we know kids don’t get so sick [from Covid-19] it’s possible that a higher proportion could become immune and can’t transmit it, which is known as herd immunity.”
But Carapetis warned although there is a “good theoretical basis” for that view, there is so far no data to back it and it is only an assumption that children will gain immunity once infected. As such, it should “not be a significant factor” in potential school closures.
On Sunday, Paul Kelly, the deputy chief medical officer, said: “And that important issue of herd immunity that we talk about a lot in vaccination is exactly the challenge that we have at the moment. There is no herd immunity. Everyone is susceptible to this virus in Australia.”
Phelps said there was “no point talking about herd immunity … unless you’re talking about immunisation, and we don’t have a vaccine for coronavirus”.
“If you had a vaccine, you would get as many people vaccinated as possible,” she told Sky News.
“You don’t increase herd immunity by making as many people as possible sick so that they then transmit the virus to someone who can’t cope with it.”
Will schools eventually close?
The Victorian premier, Daniel Andrews, has suggested school closures are “inevitable”.
The Australian Medical Association’s Western Australian president, Andrew Miller, has predicted widespread school closures will happen in the near future.
“The schools, we need a bit of preparation time, but it will be coming,” he reportedly told the ABC. “Sometime in the next few weeks we would expect the government would be looking closely at that.
“I suspect what will happen is that schools won’t go back after the holidays.”
Sutton noted that for pre-emptive school closures to be effective they would need to be “prolonged” and it was unclear when they would reopen.
Sutton has suggested that “school closures may still be considered late in the outbreak in anticipation of a peak in infection rates for a shorter period of time”.