Anxiety

Should I Send My Child to School? Am I in Denial or Panic?

Why does official policy on school closure differ from country to country?

Posted Mar 16, 2020

This post is by Dr. Raj Persaud. Dr. Peter Bruggen, sadly, has passed away.

When confronted with unpalatable actions we may need to take but don’t want to, like making difficult changes to our lives in response to the threat of a virus pandemic, psychological defence mechanisms spread like wildfire.

A pandemic of denial can grip a population anxious to avoid confronting catastrophe.

 Image by Vektor Kunst from Pixabay
An artist's impression of a virus like coronavirus
Source: Image by Vektor Kunst from Pixabay

Is this happening with the current virus outbreak? Or is the opposite psychological mechanism to denial, which is panic, now more endemic? When we panic, we often react in terror to a scenario which is much worse than the actual facts warrant.

One of the latest headlines on the BBC News website, which currently illustrates the tricky problem of remaining dispassionate, as opposed to the lurch from denial to panic and back again, is: "Coronavirus: Why is the UK not shutting schools like other countries?"

This is an article written by Pallab Ghosh, the BBC’s science correspondent, which goes on to state: "It is important to stress that this strategy has been drawn up based on evidence and input from many of the world's leading scientists and doctors, many of whom have been involved in controlling the spread of the virus in China and Singapore. And it is notable that no UK epidemiologists—specialists in the spread of diseases—have spoken out in the mainstream media against the UK government's approach."

But then at the bottom of the article is this caveat: "Clarification 14 March 2020: An earlier version of this article said no scientists had spoken out against the government. This has been updated to make clear that, at time of publication, no UK epidemiologists had spoken out in the mainstream media."

How to resolve the controversy? Is the government also, possibly, in denial? Or behind the scenes, is it panicking, but just keeping their terror from us?

In a research paper entitled, "School closures and influenza: systematic review of epidemiological studies," authors based at the London School of Hygiene and Tropical Medicine and The Health Protection Agency analysed and reviewed almost 80 studies from around the world.

The review published in the academic journal BMJ Open concludes that the available evidence suggests: "Influenza incidence frequently declined after school closure. The effect was sometimes reversed when schools reopened, supporting a causal role for school closure in reducing incidence. Any benefits associated with school closure appeared to be greatest among school-aged children."

However, the authors, Charlotte Jackson, Emilia Vynnycky, Jeremy Hawker, Babatunde Olowokure and Punam Mangtani, also pointed to two studies of the 2009 pandemic that suggested that school closure also decreased infection incidence in adults.

One study, they quoted, in England, estimated, "case numbers in most age groups decreased during the summer holiday and increased when schools reopened." Another in Serbia, found, "incidence decreased among 5-year-olds to 14-year-olds and 15-year-olds to 64-year-olds during a 1-week school closure."

The USA has also followed the UK in not advocating widespread school closure, unlike several other countries, such as Ireland, France and Denmark, amongst many other northern European countries, who have all shut schools. There is currently a national petition demanding that the UK government abandon its current official policy on school closure.

What about the situation in the USA?

In a recent study entitled, "School dismissal as a pandemic influenza response: When, where and for how long?" authors from The Los Alamos National Laboratory, Centers for Disease Control and Prevention, Atlanta and Monash University, Australia, used computer simulation models to evaluate the likely impact of coordinated pre-emptive school dismissal policies during an influenza pandemic.

The authors, Timothy Germann, Hongjiang Gao, Manoj Gambhir, Andrew Plummer, Matthew Biggerstaff, Carrie Reed and Amra Uzicanin, explain that their research is the most comprehensive modelling study to evaluate the effectiveness of different school-closure strategies in mitigating influenza in the United States during an evolving pandemic.

The research, published in the academic journal Epidemics, concludes that during the period before vaccines become widely available, school dismissals are particularly effective in delaying the epidemic peak, typically by four to six days for each additional week of dismissal.

The authors of the study, which was prophetically published in 2019 before the current outbreak, conclude that in the USA, broader (multi-county) school dismissals should be considered for the most severe and fast-spreading pandemics. The study also concludes that multi-month closures may be necessary to delay the epidemic peak sufficiently to allow for vaccines to be implemented.

For example, the authors say that their modelling suggests that "simultaneous (co-ordinated) school closures proactively implemented over a wider region are usually superior in terms of number of cases averted if the closure is sustained over a longer period of time (8 weeks or more…)."

The authors of the paper also concede the following: "In the absence of clear evidence for the effectiveness of school closures on large geographic scales, it has been very difficult for public officials to make policy recommendations and develop national guidance. Mathematical and computational disease spread models offer invaluable platforms for performing 'what-if' studies to assess potential future pandemic scenarios and intervention strategies, complementing observational or field studies that are necessarily limited to historical events and decisions."

But the authors also conclude: "Our findings are consistent with previously published studies considering school closures as the only intervention in response to an evolving pandemic. In particular, prior observational and modelling studies suggested that schools are the key community setting for pandemic influenza transmission."

A study entitled, "The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment," calculated the impact of widespread enduring school closure on the economy.  

The authors, Richard Smith, then Professor of Health System Economics at the London School of Hygiene and Tropical Medicine, and now at Exeter Medical School, Marcus Keogh-Brown at the London School of Hygiene and Tropical Medicine, Tony Barnett, now at The London Centre for Neglected Tropical Disease Research, and Joyce Tait, a Scientific Adviser to the Government, calculated that 15.5% of the workforce comprises women who are probably responsible for dependent children.

Adding in the smaller proportion of working men also reported to be responsible for dependent children brings potential work absenteeism estimates through school closure, according to this analysis published in the British Medical Journal, to 16.1% of the UK working population.

We are constantly being told that officialdom is being transparent with us about the predicament we face, and maybe they are.

Maybe they are calmly and rationally revealing their true mental state, which remains unflustered.

But, another possibility, is that the prospect of some of these numbers is pushing our leaders into denial or panic.

References

Epidemics Volume 28, September 2019, 1003482019 doi: 10.1016/j.epidem.2019.100348. School dismissal as a pandemic influenza response: When, where and for how long? Germann TC, Gao H, Gambhir M, Plummer A, Biggerstaff M, Reed C, Uzicanin A.

School closures and influenza: systematic review of epidemiological studies Charlotte Jackson, Emilia Vynnycky, Jeremy Hawker, Babatunde Olowokure, Punam Mangtani BMJ Open Volume 3, Issue 2

https://bmjopen.bmj.com/content/3/2/e002149?int_source=trendmd&int_medium=cpc&int_campaign=usage-042019

The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4571 (Published 20 November 2009) Cite this as: BMJ 2009;339:b4571 Richard Smith, Marcus Keogh-Brown, Tony Barnett and Joyce Tait.