Plans to reopen schools in Malaysia remain controversial. Should they be?

A.D. Stevens??September 2021

“What you measure affects what you do. If you don’t measure the right thing, you don’t do the right thing.” Josepth Stiglitz

It is now September 2021 and all of Malaysia’s schools continue to be closed. In fact, the country’s 7,962,033 school-aged children are in their 48th week of home-based remote learning since March 2020.?Malaysia is one of just 17 countries worldwide which continues to use national school closure as a response to COVID-19,[1]?affecting 6.5% of the global school-aged population.?Why have 178 countries chosen a different educational path?

The obvious and commonly rehearsed answers are that the risk is too great to reopen schools and there is no imperative to do so. In July 2021, this was opined by the National Parent-Teacher Association (NPTA) which cautioned the Malaysian Ministry of Education against reopening schools in a hurry[2] and two months later the same refrain came from the president of one of the country’s larger political parties: “Do not take risks over matters that we are not sure about. There is no need to rush[3].”

Context

The context is that Malaysia is experiencing one of the most rapid spreads of COVID-19 in South-East Asia and there is an understandable fear of the virus not just entering schools, but of them becoming multipliers as fresh vectors of infection, so they remain closed, pending vaccination of teachers and children.

However, a crucial nuance in measurement seems to have been almost overlooked by the Malaysian media and the public. In August 2021, the government announced that the country’s recovery stages would be measured by critical illness, not a tally of daily infections[4]. Although the news media continue to print headlines about the dizzying number of daily new cases, the shift to the metric of hospitalisation marked the beginning of a solution-focused policy. This recognises that typically fewer than 2% of infections require hospitalisation, that the majority are asymptomatic and that COVID-19 will be with us for a long time, becoming endemic.

A month after the adoption by the government of ICU usage to signpost Malaysia’s recovery, a national newspaper’s header on all media still omits the recovery KPI.

First Response

In March 2020, when most schools worldwide shut their doors, little was known about SARS-CoV-2 and the natural precautionary response was to assume incorrectly that it behaved like influenza[5]. “We closed schools early, not only to help flatten the curve, but also because for most respiratory illnesses, children are at most at risk[6],” according to John Bailey who recently reviewed the literature on schools and COVID-19 for the American Enterprise Institute. This initial cautious measure was repeated on a global scale in the second quarter of 2020.

Closing schools certainly prevented any chance of them recording or becoming vectors of infection. However, the educational and societal consequences of such a centralised and absolute approach is much too severe to be a feasible long-term strategy.

What happens when schools close?

Education

Most obviously, regardless of weighted national exam results to compensate for disadvantages, children’s academic development has slowed[7]. A McKinsey study[8] found that in the USA a year ago at the beginning of the new Autumn 2020 school term, on average children were 5 months behind in their learning of Maths and English, the trend continued with further closures and was accentuated among racial and social minorities, which is a trend that has been identified universally[9].

School closures deprive the youngest children of the optimum context for brain development at precisely the stage when their synapses are growing at their fastest and making the connections needed for pivotal higher-level abilities like motivation, self-regulation, problem solving and communication[10]. ?

This reinforces social, gender and racial inequalities and limits social mobility, as does digital poverty and the limitations of access to the resources and encouragement needed to succeed without school, especially among girls[11].

UNESCO estimated last year that around 24 million children dropped out of school as a result of closures during the pandemic[12] and did not return.

Health

School closures and children’s isolation have repeatedly been linked to ?mental illness and depression, deteriorating physical health and nutrition[13], while increased time online exposes children to more cyber-bullying[14].

Schools play such an important role in identifying and protecting ?children who are at risk of or experiencing domestic abuse, that their closure has seen worrying trends during the pandemic[15]. ?

In summary, UNICEF’s Chief of Education, Robert Jenkins,?concludes that because schools provide so many essential services in addition to teaching, they should be the last to close and the first to open. In Malaysia, the reverse has been the case.

Economy

There is another less obvious imperative, albeit one that is always subject to operational safety: the economic impact of private fee-paying institutions. Typically, they enjoy favourable staff to pupil ratios, space, resources and protocols which mean that they have managed risk and safeguarded the health of pupils and employees scrupulously because their very existence depends on it and therein lies the key nuance: these are both schools and businesses. However, at a time when all shops, industries and even cinemas reopen in Malaysia, private and international schools continue to be treated only as schools; this is not sustainable for the sector and not tolerable for the parents who pay for a service. While publicly funded schools can lock their gates indefinitely, notwithstanding the proven disadvantages and dangers to children that are reinforced by prolonged closures, the private and international sector does not have that option. Its enforced closure is attritional because its fee-paying parents have choice which many continue to exercise by leaving Malaysia, dismissing online teaching in favour of a real school experience elsewhere – almost anywhere else - removing their children and their funding.?

As the very survival of the sector is threatened by the continued imposition of public-sector restrictions and the steady collapse of educational tourism, it is not just the sector that suffers. Such schools in Malaysia are also often key consumers, stimulating local economic networks which are in atrophy as demand disappears. Pre-pandemic overseas students contributed RM15.6 billion directly to the Malaysian economy[16] and, even more importantly, provided invaluable infrastructure for economic growth, both retaining an internal market which would otherwise have looked overseas and the families of expatriate investors. In the longer term, the impact on GDP of a skills deficit and lower social mobility is likely to be felt for decades. McKinsey has estimated that the cost of the deficit in numeracy and literacy among K-12 children in the USA, where school closure has been shorter than in Malaysia, will be approximately $188 billion per annum[17].

Few other self-funding businesses which contribute to the economy and the nation’s infrastructure continue to operate under such unsympathetic and unsustainable conditions.

The fear factor

So, school closure is not a long term strategy and it is encouraging that most governments have explored a means of permitting schools to reopen. In Malaysia, there are plans to vaccinate children aged 12-18. However, 4,084,187 of the 7,962,033 children in Malaysia[18] are under 12 and they will not receive a vaccination. The reason for their continued absence from school is unclear.

Caution is sensible and fear is understandable, but ignorance is unnecessary and the news media have not helped by focusing on data which is not false, but is equally not helpful and rarely includes the key metrics. In the USA, as in Malaysia and other countries Tracy H?eg observes that?“It has been perpetuated in the media that COVID is dangerous, kids are super-spreaders and schools are super-spreader places, and none of that has been validated in the scientific literature,” as her studies in Wisconsin and elsewhere show[19].

Assessing the risk

There is, of course, a risk and it is important to identify and quantify it. As COVID-19 continues to become endemic, asymptomatic and mild infections are becoming increasingly commonplace. Infection, therefore is an increasingly likely, but not a serious risk, even though it continues to make headlines.

Instead, concerns should rationally focus on serious illness and the question of the risk that it poses to children. In an extensive test of pupils and staff, the UK Office of National Statistics found that 1.24% of pupils and 1.29% of staff tested positive for the infection, mirroring an estimated 1.2% infection rate in the general population, prompting Dr Jenny Harries, England's Deputy Chief Medical Officer, to conclude that schools were "not a significant driver" of cases of COVID in communities[20]. The same study, which claims to be the most comprehensive anywhere into the impact of the pandemic on young people, concurred with many others that “severe illness and death in children and young people are rare.”?

Concerns have been heightened by the emergence the variant of concern B.1.617.2, or Delta, which is more transmissible, but not more virulent than the Alpha variant, B.1.1.7. Delta is now the dominant variant in many countries, including the United Kingdom, where cases increased?exponentially, with a doubling time of 11 days in June 2021[21].

In the UK 2 children per million are being hospitalised due to COVID-19 and public health data indicates that most have underlying health conditions[22]. Of course, despite growing evidence supporting mask-use, it remains culturally controversial in western nations. The UK Department for Education stopped recommending face coverings for pupils and staff on 17th May; two months later they became largely optional everywhere and distancing was abandoned. Yet, following an efficient vaccination campaign, the UK‘s National Health Service has not been stretched beyond capacity by the relaxation of precautions and, as the ONS chart illustrates, serious illness has not tracked the rate of infection, most of which has been asymptomatic, as it is in Malaysia.

UK register of COVID-19 and non-COVID mortality

On Friday 10th September Denmark, which was the first northern European country to introduce COVID-19 restrictions in March 2020, will end all mandatory precautions, close its extensive rapid testing facilities and school children will no longer be sent home if a classmate or teacher contracts COVID-19. As 72% of its population and 95% of those who are most vulnerable reach full vaccination, Magnus Heunicke, the Danish Health Minister announced “COVID-19 is no longer a critical threat to society. The epidemic is under control.[23]” Professor Viggo Andreasen, from Roskilde University’s Pandemics Centre concurs: “We are seeing little serious disease in Denmark, so there’s definitely an understanding among politicians and the public that this is not a threat to society.[24]” The levels of serious illness due to COVID-19 in Denmark show a similar pattern to those in the UK and are even more encouraging, as the comparison chart below illustrates. Malaysia has vaccinated 69% of adults and, at its current pace, will reach 70% of the whole population within 26 days[25] (3rd October 2021).?

Comparison of COVID-19 hospital admissions UK and Denmark

Dr Yvonne Doyle, Public Health England's Medical Director recently empathised with parents, but reassured them that schools are not "drivers" or "hubs" of infection, stressing that measures to limit the spread of COVID-19 remain in place.[26] Mitigating measures are, of course, much more universally applied in Malaysia where they remain mandatory, expected and accepted and would reduce the marginal risk of serious illness even further.

The future

To resume education coherently and with national confidence, expectations of schools and their operational protocols must align with those of national recovery. Schools cannot and should not be expected to adopt or deliver zero COVID, when the pace of society’s recovery elsewhere accepts that eradication of the virus is not an option and is therefore being determined by the level of serious illness.?

The bulk of the literature on transmission in schools in all contexts, suggests that children have not driven viral spread. Studies throughout the world have consistently shown very low infection rates within school settings and the consistent use of mitigating measures once schools have reopened has been overwhelmingly successful in identifying and isolating cases which appear largely to have been brought from external indices, allowing children to learn again in environments which are essential to their development.

Just as government and society adjusted their outlook and practices at the onset of pandemic in 2020, now as COVID-19 becomes endemic, they must adjust again to acknowledge that infection per se is no longer a threat that paralyses entire nations. Leadership from government and responsible journalism must reassure and inform society that the paradigm of pandemic no longer dominates and diminishes humanity. The remarkable achievements of widespread vaccination and sensible mitigation permit us and our children to flourish again.

A.D. Stevens

Johor

Malaysia

September 2021

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[1] UNESCO, Education: From Disruption to Recovery (2020), UNESCO Institute for Statistics, https://en.unesco.org/news/covid-19-learning-disruption-recovery-snapshot-unescos-work-education-2020.

[2]Basyir M., No need to rush to reopen schools, says NPTA president (19 July 2021), New Straits Times.

[3] FMT Reporters, Don’t rush, reopen schools only if we are ready (4 September 2021), FMT.

[4] Star Reporters, NRP: Number of serious cases new indicator for phase transitions, says Zafrul (5 August 2021), The Star.

[5] Jackson C. et al, The relationship between school holidays and transmission of influenza in England and Wales (2016), American Journal of Epidemiology, https://pubmed.ncbi.nlm.nih.gov/27744384/

[6] Bayley J., Is it safe to reopen schools? An extensive review of the research (2021), American Enterprise Institute, https://www.aei.org/research-products/report/is-it-safe-to-reopen-schools-an-extensive-review-of-the-research/

[7] Donnelly, R. and Patrinos H., Is the COVID-19 slide in education real? (2020), Education for Global Development by The World Bank, https://blogs.worldbank.org/education/covid-19-slide-education-real

[8] Dorn E. et al, Covid-19 and Education: the lingering effects of unfinished learning (2021), McKinsey and Company, https://www.mckinsey.com/industries/public-and-social-sector/our-insights/covid-19-and-education-the-lingering-effects-of-unfinished-learning

[9] The DELVE Initiative, Balancing the Risks of Pupils Returning to Schools (2020), The Royal Society’s Multi-disciplinary Data Evaluation and Learning for Viral Epidemics (DELVE) group, https://rs-delve.github.io/reports/2020/07/24/balancing-the-risk-of-pupils-returning-to-schools.html.

[10] Shonkoff J et al, Young Children Develop in an Environment of Relationships: Working Paper No. 1 (2004), National Scientific Council on the Developing Child, www.developingchild.harvard.edu.

[11] Fry, L. et al, Girls’ education and COVID-19: What past shocks can teach us about mitigating the impact of pandemics (2020), The Malala Fund, https://downloads.ctfassets.net/0oan5gk9rgbh/6TMYLYAcUpjhQpXLDgmdIa/3e1c12d8d827985ef2b4e815a3a6da1f/COVID19_GirlsEducation_corrected_071420.pdf

[12] Press Release, UN Secretary-General warns of education catastrophe, pointing to UNESCO estimate of 24

million learners at risk of dropping out (2020), UNESCO, https://en.unesco.org/news/secretary-general-warns-education-catastrophe-pointing-unesco-estimate-24-million-learners-risk

[13] Van Lancker W. and Parolin Z., Covid-19, school closures and child poverty: a social crisis in the making (2020), Lancet, https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30084-0/fulltext

[14] Fantini M., Covid-19 and the reopening of schools: a policy-maker’s dilemma (2020), Italian Journal of Pediatrics, https://ijponline.biomedcentral.com/articles/10.1186/s13052-020-00844-1

[15] Devarayalu, L., Why we must reopen schools now (2020), New Indian Express, https://www.newindianexpress.com/opinions/2020/aug/28/why-we-must-reopen-schools-now-2189316.html

[16] Ministry of Education Secretary-General, Mohd Ghazali Abas (2019), reported in https://thepienews.com/news/malaysia-to-recalibrate-strategy-as-200000-target-looks-out-of-reach/

[17] Dorn E. et al, Covid-19 and Education: the lingering effects of unfinished learning (2021), McKinsey and Company, https://www.mckinsey.com/industries/public-and-social-sector/our-insights/covid-19-and-education-the-lingering-effects-of-unfinished-learning

[18] UNESCO, Education: From Disruption to Recovery (2020), UNESCO Institute for Statistics, https://en.unesco.org/news/covid-19-learning-disruption-recovery-snapshot-unescos-work-education-2020

[19] Benda E., COVID-19 Cases and Transmission in 17 K-12 Schools - Wood County, Wisconsin, August 31-November 29, 2020 (2021), Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, https://pubmed.ncbi.nlm.nih.gov/33507890/

[20] Clark M. et al, Deaths in Children and Young People in England followingSARS-CoV-2 infection during the first pandemic year: a national study using linked mandatory child death reporting data (2021), Research Square, https://assets.researchsquare.com/files/rs-689684/v1/3e4e93fb-4e98-4081-9315-16143c2bbd2b.pdf?c=1625678600

[21] Riley S., REACT-1 round 12 report: resurgence of SARS-CoV-2 infections in England associated with increased frequency of the Delta variant (2021), MedRxiv, https://www.medrxiv.org/content/10.1101/2021.06.17.21259103v1

[22] Clark M. et al, Deaths in Children and Young People in England followingSARS-CoV-2 infection during the first pandemic year: a national study using linked mandatory child death reporting data (2021), Research Square, https://assets.researchsquare.com/files/rs-689684/v1/3e4e93fb-4e98-4081-9315-16143c2bbd2b.pdf?c=1625678600

[23] Nikel D., Denmark lifts all Coronavirus restrictions except entry rules (2021), Forbes, https://www.forbes.com/sites/davidnikel/2021/08/27/denmark-lifts-all-coronavirus-restrictions-except-entry-rules/?sh=a34b65571dd5

[24] Orange R., Is Denmark about to show the world what living with Covid looks like? (2021) Daily Telegraph.

[25] CovidVax.Live (2021), https://covidvax.live/about

[26]Atkins B., The impact of school reopening on the spread of COVID-19 in England (2021), Philosophical transactions of the Royal Society, https://royalsocietypublishing.org/doi/10.1098/rstb.2020.0261

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