As summer holidays come to an end, parents everywhere are getting ready to start the new school year. This year feels unlike any other year, as some parents will be sending their kids to school while others will have them learn from home. Whether it’s safe or not to open schools has been controversial for the past months, but the good news is that a growing number of studies from countries that have opened schools show that the answer may not be one or the other. It is possible for schools to open safely by focusing on hygiene, social distancing and rapid public health responses that keep community transmission low.
What do we know from countries that have opened schools?
Data collected from studies in Australia and Europe show that schools can open safely when community transmission is low. A survey by the European Center for Disease Prevention and Control found that reopening school in several European countries was not associated with a significant increase in the number of cases. Sweden and Iceland kept preschools or primary schools open with measures (e.g. hand hygiene, physical distancing, staying home when ill, etc.) during their epidemic did not report larger numbers of hospitalized cases among children, despite the overall outbreak being severe and prolonged in Sweden. EU countries that partially opened their schools before the summer break, often with community measures, have not experienced school outbreaks. (1)
In New South Wales in Australia, a study analyzed data from schools and day-care centers that remained open for children of healthcare workers between late January and early April. During that period, the state had an average of 193 cases per day. Out of 7,700 open schools and daycare centers, only 25 reported an infectious child or staff during that period. Secondary transmission was only reported in 3 out of 15 schools and 1 out of 10 daycares. Only 1 daycare center had a sustained outbreak. It’s worth noting that very strict public measures were applied in the state, as well as effective testing and contact tracing. (2)
Where there any negative experiences to look out for?
One outbreak was reported in a high school in Israel 10 days after reopening schools in May. At the time, there were 127 cases per day (15 cases per million people). The outbreak affected 153 students, 25 staff and 87 family members and friends. What were the conditions that lead to this? The students were in air-conditioned rooms with 30 classmates not wearing masks.
A similar outbreak was reported in Chile, where classrooms were also crammed with more than 30 children. These examples suggest that the key contributors to the outbreaks poor ventilation, large classroom sizes and the lack of wearing masks. (3)
The bottom line from the above experiences is to comfort parents that schools can still be a safe place. None the less, it’s important for schools to be vigilant about the public health measures: illness policies, diligent masking, appropriate class sizes, avoid gatherings, social distancing and hand washing. Testing and contact tracing in the community are absolutely essential to avoid outbreaks. Going back to school may not be the SAFEST option but it's important to objectively weigh the risks against the evidence. Once again, there is nothing black and white about the decisions we make while living with COVID-19.
2) Macartney, K. et al. Lancet Child Adol. Health https://doi.org/10.1016/S2352-4642(20)30251-0 (2020).
3)Stein-Zamir, C. et al. Eurosurveillance https://doi.org/10.2807/1560-7917.ES.2020.25.29.2001352 (2020).
Public health is not one thing, it's a broad field which makes understanding what a public health professional does for a living a little confusing. It ranges from managing health data through statistics to knowing how to use data when managing services or advocating for health policies.
Here are the top 5 specialties in Public Health:
1. Epidemiology: This is the core of public health. It's the study of the distribution and determinants of health related events in specified populations, and the application of this to control of health problems. They study the movement and trends of diseases through a population, as well as investigate how diseases spread and how they can be slowed down. In a nutshell, it's about finding and monitoring disease patterns in population data and using these findings to inform decisions.
Common job titles: Field Epidemiologist, Health Data Analyst, Field investigator
2. Health Policy and Management: Health policy and management professionals use public health research to inform health policy. They need to be knowledgeable about health economics, politics, management and finance. Whether in business, nonprofits, or government, health organizations need policy advisers to help them decide the impact of regulations, and policies governmental organizations impose upon the public and on businesses. Health policy workers may be responsible for creating policies that ensure equitable access to medical care and provide health services.
Common job titles: Health policy analyst/advisor, Health services manager, Governmental administrator
3. Health Promotion:
This specialization focuses on communication and marketing methods to promote healthy practices. Through education programs, they aim to influence the behavior of others and empowering them to to take responsibility of their own health. Those working in this area will most likely be managing wellness programs, writing grant applications and working on public messages to address a health crisis.
Common job titles: Health education specialist, Public relations manager, Medical writer
4. Environmental Health:
This focuses on how external factors such as social factors, climate change and pollution influence the health of populations. Professionals working in environmental health will be found working in research, occupational health, creating and implementing environmental projects that improve the health of communities.
Common job titles: Environmental specialist, quality investigator
5. Global Health:
Global health is the understanding of healthcare with an international perspective by focusing on eliminating health disparities, improving access to healthcare and fostering policies that encourage healthy habits. Their work will most likely be in Non-governmental and international aid sectors (the most famous global health organization is the World Health Organization). It could involve traveling to countries with low resources for field work to implement or monitor health programs.
Common job titles: Health access project manager or coordinator, Infectious diseases educator, Humanitarian crisis field officer
I have been passionate about public health long before I took the decision to pursue it as a graduate degree. I can safely say that this is the first year I no longer have to offer an extended explanation to anyone who asks me about my career plans! It took a whole pandemic to shed light on this beautiful but often neglected field.
What I find interesting is that even in the medical field, many are not aware of the details of the profession and its importance. When a high school graduate interested in health sciences is given the option to choose the career that they want to spend the rest of their life doing they are usually provided with a few known options: medicine, dentistry, pharmacy or nursing. Those are no doubt the front-line workers who make up the visible healthcare work force however, there are so many soldiers who contribute to the success of a health system.
Since it's august and many high school and university graduates are busy choosing fields to study, I decided to clarify what public health is and what kind of work public health professionals do.
Public health focuses on the entire spectrum of health and well-being, giving a holistic overview of what being healthy means on a population level. As opposed to clinical health services, It takes into account the health of the whole population rather than the individual.
Public health can be broken down into 3 Ps: Prevention, Promotion and Protection.
One of the most discussed topics, viewed as the light at the end of the tunnel to many is when COVID-19 vaccine will become available. There are many candidates that have already reached phase 3 in clinical trials, meaning it is already being tested on healthy individuals.
Many are worried about the logistics of the vaccines once it becomes available, and a phenomena now known as "vaccine nationalism" is on the list of worries of many public health experts. According to experts, health workers and high risk individuals should be the first to be given the vaccine. However, high income countries will most likely be first on the list to receive the early doses of the vaccine leaving high risk people and health workers in poorer countries exposed to the virus.
Looking at past trends, HIV treatment became widely available in Africa, the continent with the highest prevalence of HIV, 7 years after revolutionizing HIV treatment in Western countries. Similarly, during the H1N1 pandemic, countries from the global north donated 10% of their vaccine stocks after securing enough for their populations.
One way to make sure that the vaccine will be distributed equitably is through a new agreement initiated by the WHO known as the Covid-19 vaccine global access facility (COVAX). This will encourage high income countries to be involved in the equitable distribution of the vaccine by reducing their risk, incase they bet on the wrong vaccine candidate they will still receive enough doses from the winning vaccine, without compromising the share of low income countries.
This is one way we can avoid a scenario where the new vaccine first doses are reserved for rich countries, leaving out high risk groups in poor countries who need the vaccine most. In a world where it has never been more evident how connected we all to each other, we can not expect to overcome this without an equitable plan that leaves no one behind.
Many have speculated that the virus will continue circulating until the year 2021 when a vaccine becomes available. The question on many people's minds is how much longer until our lives can go back to normal? This is a tough question and I think a more appropriate question is: what needs to be in place for a society to safely start opening up again?
Opening up the society is something that has to happen eventually in order for life to continue in parallel to COVID-19. The goal of any country at this point will be to balance public health measures and economic contingency, with the overall public health of the population being a priority.
The WHO has recently published the criteria for countries to gradually lift suppression measures, or “exit strategies”. This is a quick summary of what needs to be in place before that happens:
Controlling COVID-19 transmission to a level that can be managed and traced.
These new protocols won’t be effective if members of a community don’t recognize the role they play. Wearing a mask, personal hygiene and physical distancing are a choice each person will have to make every time they leave the house. It will not be easy to change our habits and different societies might be more or less accepting of these new constraints. This cautious way of life may be a little daunting at first, but it’s a beautiful reminder of our collective responsibility towards one another. This isn’t advocating living in fear from a virus, it’s advocating pursuing something bigger than our individual interests. Our old ways of life may be gone for now, but hope for a better world is very much alive.
1. Kissler, S. M., Tedijanto, C., Goldstein, E., Grad, Y. H., & Lipsitch, M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science. 2020.