Šole niso žarišče okužb, njihovo zapiranje je neučinkovit ukrep, prinaša pa velike negativne družbene posledice

V vseh EU državah se je zapiranje šol izkazalo kot neučinkovit ukrep za omejevanje širjenja okužb. Regresijska analiza na podlagi podatkov OWiD med indeksom zaprtja šol in pojavnostjo Covid primerov kaže, da med obema ni značilne povezave. Za Slovenijo pa je povezava med obema močno pozitivna, ker se je kljub popolnemu zaprtju šol raven okužbe še naprej ohranjala na zelo visokem nivoju (slika spodaj). Če bi bilo zaprtje šol učinkovit ukrep, bi morali dobiti negativno korelacijo.

Slovenija - Zaprtje šol in 7-dnevna pojavnost Covid-19

Vir podatkov: OWiD; lastna slika.

Podobno ugotavljajo povsod v EU. Spodaj objavljam članek epidemiologa Devija Sridharja, vodje oddelka za globalno javno zdravje na University of Edinburgh, ki je sodeloval pri pripravi Poročila DELVE (pregled analiz glede povezanosti odprtja šol in Covid epidemije) za Royal Society, ki služi kot input svetovalni skupini britanske vlade Sage in svetovalni skupini Covid-19 škotske vlade. Sridhar navaja, da čeprav je  eden glavnih razlogov, ki ga navajajo vlade za zaprtje šol, tveganje, ki ga okuženi otroci lahko predstavljajo učiteljem, pa je Svetovna zdravstvena organizacija ugotovila, da je najpogostejši način širjenja virusa v šolah prenos med osebjem. Manj običajno je, da se virus prenaša med osebjem in učenci, medtem ko so možnosti, da se virus širi od učenca do učenca, redke. Prav tako ni gotovo, ali šolarji predstavljajo tveganje za člane svojega gospodinjstva; analiza več kot 9 milijonov odraslih v Angliji, ki živijo v gospodinjstvu z otroci, starimi 11 let ali manj, ni pokazala večjega tveganja za Covid-19.

Zato je, namesto da o šolah razmišljamo kot o žariščih prenosa, ki dodatno povzročajo naraščanje števila primerov med prebivalstvom, bolj primerno, da jih obravnavamo kot odsev obstoječe stopnje prenosa virusa: ko se primeri povečajo v skupnosti, se poveča tudi število izbruhov v šolah. Toda pa slednje ni nujno vzrok za povečanje prenosa v skupnosti. 

Sridhar zato poziva, da damo na stran politične igre in egote ter se začnemo uravnoteženo pogovarjati o optimalnih rešitvah, da ohranimo šole odprte tudi v bližnji prihodnosti. To pa pomeni redna testiranja, prednost učiteljem in šolskemu osebju pri cepljenju, dodatna sredstva za izboljšanje prezračevanja in čiščenja zraka v učilnicah, čim več gibanja zunaj, spomladi čim večjo uporabo zunanjih prostorov za pouk itd.

Čeprav ne gre za lahke odločitve, pa jih je treba sprejeti ob ustreznem pretehtanju tveganj – torej med možnostjo, da pride do lokalnih izbruhov okužb v posameznih šolah in škodo, ki jo povzročamo celotni generaciji mladih, ker smo jih s popolnim zaprtjem šol prikrajšali so kvalitetno izobraževanje in socializiranje ter s tem za boljše možnosti v življenju. 

So far, we know that closing schools for everyone except vulnerable children and those of key workers entrenches educational inequalities. This has an irreversible effect on people’s life chances. No amount of financial support can completely mitigate or reverse these harms, because schooling goes far beyond literacy and numeracy; it’s also about social and physical development and providing safe places where children can access supportive adults. Moreover, we know the impact of school closures falls largely on women; during the first lockdown, 41% of working women struggled to find childcare to cover their hours.

What’s also becoming clear is that we may have overestimated the effectiveness of closing schools. The return of schoolchildren in mid-August doesn’t appear to have been the driving force in the surge in cases many European member states experienced during the autumn, according to a recent review from the European Centre for Disease Control. There also seems to be a difference between primary age children (4-11), who are underrepresented in cases and outbreaks, and older children (11-18), who fall in line with other age groups.

The scientific consensus is that children are largely unharmed by Covid-19. Although they may be carriers, they rarely experience its worst symptoms. Indeed, children up to age 18 have lower rates of hospitalisation and deaths than all other age groups. But this doesn’t mean they’re entirely unaffected; in the US more than 1,000 children have been admitted to hospital with MIS-C, a serious but rare condition associated with Covid-19. We still need to suppress Covid-19 in children, or we risk not only some of them being hospitalised but also giving the virus more chances to mutate.

One of the main reasons for closing schools is the risk that infected children may pose to teachers. But, as the World Health Organization has noted, transmission between staff is the most common way the virus spreads. It’s less usual for the virus to transmit between staff and pupils, while the chances of the virus spreading from pupil to pupil are rare. It’s also not certain whether schoolchildren pose a risk to members of their household; one analysis of more than 9 million adults in England who shared a household with children aged 11 or under did not indicate an increased risk of Covid-19 (though it’s worth noting this analysis didn’t include teenagers).

Instead of thinking about schools as zones of transmission that cause case numbers to rise across the population, it’s more accurate to think of them as reflections of the existing rate of transmission: when cases rise in a community, so do the number of outbreaks that occur in schools. But the latter is not necessarily the cause of the former. In Scotland, when schools were reopened full-time in August 2020, the country had managed to suppress Covid over the summer, and 75% of schools had no cases of Covid-19 in the first half-term. And half of the schools with Covid-19 only had a single case. But as the term continued into December, the rising number of school outbreaks coincided with rising positivity rates across communities.

The new variant complicates this picture. Scotland made the decision before Christmas to delay reopening school until late January, except for vulnerable children and those of key workers. This was a precautionary move due to questions about the new variant, including how much more transmissible it is, how quickly restrictions can bring its prevalence down, and whether the variant changes the infectiousness of children. We still don’t have good answers to these questions, which is part of the scientific uncertainty that ministers must grapple with when making decisions.

But we know far more than we did 10 months ago. The fastest way to get schools open is to reduce the number of infections across the population. This means we must all adhere to restrictions, limiting our mixing with others, avoiding indoor gatherings, staying away from crowds and remaining at home at much as possible. It’s also clear that reopening preschools, nurseries and primary schools will pose less of a risk to Covid transmission than reopening secondary schools.

The greater challenge is keeping schools open for the foreseeable future, and avoiding a situation where outbreaks force bubbles and entire classes of children to isolate intermittently, disrupting their education. There are things the government could do to help schools remain open: it could deliver regular testing in schools to catch surges in infections, and provide supported isolation for students, ensuring they have a home computer, access to wifi, and that their parents have childcare support. It could prioritise teachers and school staff in the vaccination programme to ensure they feel safe and fully protected when doing their jobs. It could allocate funding to improve ventilation in classrooms and, as we head into spring, permit teachers to use outdoor spaces for classes.

There are no simple answers to the question of when schools should reopen. Controlling transmission and ensuring we have a functional testing, tracing and isolating programme are both necessary steps. Listening to the concerns of teachers and school staff, and putting measures in place to detect any new school outbreaks, will also be vital. It is time to put political games and egos aside: what we need is a balanced discussion on how best we can move forward. An entire generation of children depends upon it.

Vir: Devi Sridhar, The Guardian

4 responses

  1. Lep primer, kako se pri nas zadeve odvijajo mimo vseh spoznanj.
    Seveda že vsi vedo, da PCR testi niso zanesljivi, pa se kljub temu nadomeščajo s še manj zanesljivimi HAGT testi. Pri teh testih pa je pozitivna oseba obravnavana kot aktivno okužena. A ni Dr.Ihan izjavil, da vsak študent 3 letnika medicine ve – ocena bolezni ali kužnosti vedno temelji na poznavanju poteka bolezni in kombinacije anamnezije, klinične slike in preiskav, mikrobioloških in drugih … .?Kdo se tu sedaj spreneveda?

    —————–PISMO SLOVENSKI ZDRAVNIKI——————————
    Vlada Republike Slovenije

    Ministrstvo za zdravje

    Ministrstvo za izobraževanje, znanost in šport

    Nacionalni inštitut za javno zdravje – NIJZ

    Zdravniška zbornica Slovenije

    Še vedno čakamo na odgovore pristojnih institucij
    Poudarjamo, da smo pripravljeni na strokovno in znanstveno argumentiran, konstruktiven dialog »pro et contra«.
    V strokovnem mnenju smo poleg svojega stališča, podprtega z znanstvenimi viri, zastavili tudi nekaj vprašanj:
    https://slovenskizdravniki.si/strokovno-mnenje-o…/
    Citiramo:
    “- iz javnega medija je bilo možno razbrati, da bodo za testiranje učiteljev uporabljeni tudi nedavno uvoženi kitajski HAGT (11). Iz dokumentacije proizvajalca (12) izhaja, da test lahko zazna viabilne in ne-viabilne antigene novega koronavirusa. Iz protokola testiranja učiteljev (13) razberemo, da bo na testu pozitivna oseba obravnavana kot aktivno okužena. Na osnovi kakšne strokovne utemeljitve bo zdrava oseba ob navedbi proizvajalca, da test zaznava tako viabilne kot neviabilne antigene obravnavana kot aktivno okužena?
    – proizvajalec tudi navaja, da uspešnost testa morda ni v korelaciji s celično kulturo, opravljeno na istem vzorcu. Na osnovi česa se bo potem zaključevalo o uspešnosti testa? Ali se je v Sloveniji opravila validacija omenjenega testa na celični kulturi?
    – iz javnega medija (14) tudi povzemamo, da bo učiteljem ponujeno dvojno testiranje, prvo s HAGT in drugo s PCR metodo. V prispevku piše ”na NLZOH so nam pojasnili, da z dvojnim testiranjem le nadaljujejo analizo oziroma vzorčenje hitrih testov, saj je bil dosedanji vzorec prenizek za pravo analizo, kako zanesljivi so hitri testi podjetja…. Za zdaj še ne morejo trditi, v kolikšni meri so ali niso zanesljivi”. Sprašujemo se, kako je možno zahtevati obvezen poseg v telo zdravega človeka in izvajati takšno masovno testiranje s testom, ki po navedbah proizvajalca ne loči med viabilnim in neviabilnim antigenom, niti še ni bila izvedena njegova validacija? Kakšne so strokovne utemeljitve?
    – sprašujemo, če je odločevalcem in njihovim strokovnim sodelavcem poznana revizija PCR testov s strani 22 uglednih strokovnjakov (15) in priporočila SZO iz januarja 2021 (16,17) povezana z njimi? Ali in kdaj se bodo nova znanstvena spoznanja začela uporabljati v Sloveniji?
    – sprašujemo, če je odločevalcem in njihovim strokovnim sodelavcem poznano priporočilo ECDC, da se kot možna sprejemljiva alternativa ob sumu na okužbo s SARS Cov 19 testira vzorec sline testirane osebe ob uporabi PCR testa (1)? Ali se temu priporočilu sledi tudi v Sloveniji?”
    Obenem pozivamo vse kolegice in kolege, ki v okviru svojih strokovnih kompetenc in moralno-etičnih načel spremljajo ter raziskujejo tematiko, da se nam oglasijo na mail info@slovenskizdravniki.si
    Sodelujočim zagotavljamo najvišji nivo spoštovanja zasebnosti, ker sta medsebojno zaupanje in spoštovanje integritete poleg strokovnosti in sledenja kodeksu zdravniške etike naši najvišji vodili.

  2. Zakaj v slovenskem povzetku izpostavljate samo tisto, kar ustreza vašim prepričanjem? V članku piše tudi tole: “The fastest way to get schools open is to reduce the number of infections across the population.” Pri nas nam to še ni uspelo, zato morajo biti šole še vedno zaprte. Ste slučajno preverili, pri kakšnih vrednostih kazalcev imajo šole zaprte v Avstriji in Nemčiji?
    Poleg tega o članku govori tudi o novih variantah virusa, ki so stanje zakomplicirali in o katerih še nimamo dobrih podatkov.

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