Safe School Reopening Under COVID-19 Restrictions – Measures Implemented in San Andrea Independent School in Malta.

COVID-19 remains a pandemic. Public health measures, including social distancing and school closures, have prevented millions of infections and deaths.^1,2 The rationale behind school closures is a precautionary principle in that many previous epidemics (e.g. influenza) were transmitted by children.³ However, school closures have negatively impacted working parents, with economic consequences.⁴

There are equally pressing concerns regarding the impact on children’s mental and physical health if children fail to return to school.⁵ These include increased risks of childhood obesity,⁶ and the exacerbation of wealth inequality and childhood poverty.⁷

Thus far, it has been estimated that children are circa half as susceptible to COVID-19 infection as adults and are less severely affected, often presenting with milder symptoms.⁸ For these reasons, it has been suggested that reopening schools could be safe if accompanied by precautionary measures.⁹

Schools in Malta are of three types: free state schools, church schools and independent (fee paying) schools. All schools had to adapt to reopening after the summer holidays despite the possibility of outbreaks that may lead to quarantining of classes or even entire schools.^10,11

This paper describes the events leading up to school closure with reference to San Andrea Independent School in Malta, and the measures and contingency plans created during Malta’s soft lockdown and summer holidays 2020 for safe school reopening. The results vis-à-vis actual COVID-19 cases will also be presented.

Methods

School guidelines were created by San Andrea and these have been modified so as to be presented in conventional journal format.

When the first case of COVID-19 was documented in Malta, all students who had been on vacation for the Carnival holidays/mid-term were asked to self-quarantine for 14 days upon arrival.  Hand sanitizers were set up around the school and students were encouraged to bring their own.  Signs were placed around the school to remind both students and adults to wash or sanitize their hands, with diagrams on how to do this effectively.  Teachers and the school nurse took time to show younger children how they should wash their hands and reminded them regularly to do so.  Step by step instructions on how children and staff should wash their hands were placed above each sink in the bathrooms.  Only disposable paper towels were made available in the bathrooms.

Software

Schools in Malta were closed on 13th March 2020. Prior to school closures, San Andrea had commenced preparations for an online learning environment with a Virtual Learning Environments Tech Team. This team provided support, coordination and drafted contingency plans due to the very fast transition to online learning. Earlier in February, Microsoft Accounts were rolled out to students and to members of staff in Senior School (ages 11 to 15), Middle School (8 to 10 years) and Early Years (2 to 8 years). Microsoft TEAMS was the obvious choice for older students. Senior students were asked to follow a timetable with hybrid lessons - live and recorded while teachers were available on TEAMS to answer any queries and to give feedback when needed. The younger pupils utilised Class Dojo since the interface of this particular software environment suits the needs and preferences of a younger generation.

The first weeks were used to familiarise teachers and families with the software. A Microsoft-based account was given to every student from pre-nursery to Grade 7 and this gave families access to Microsoft Outlook, Microsoft TEAMS and a wide range of other free Microsoft Services (including the free Online version of Microsoft Office). Teachers started to go live and timetables were issued.

Extra Support

The transition brought many challenges.  Some children struggled both academically and emotionally. Counsellors were available to support families. Support sessions were timetabled for students who were struggling in any area of the curriculum.  Children who needed constant support were followed by Learning Support Educators (LSE) who worked not only with their own students but also with others who needed support.  Parents of children who struggled were called regularly to monitor progress and find solutions.

Further Training

After an initial four-month period of adaptation to a new system of teaching and learning, webinars were organized for additional training in the virtual learning environment. Table 1 shows the sessions given, with emphasis on the flipped learning approach which shifts the classroom from passive to active learning, focusing on higher order thinking skills so as to further engage students in learning. Students are given opportunities to take greater responsibility for their own learning and class time focuses more on exploration, meaning and application of knowledge with teachers providing learning opportunities, and feedback.¹²

E-learning

Parents who remained concerned about  sending their children to school were given the option of E-learning with live streaming of lessons made available so that the timetable could still be followed in real time together with students physically present at the school. Students were able to hear the lesson and the whiteboard contents would be projected on their computer screens at home. Homework was uploaded and corrected. Teachers from Nursery till Grade 4 used Class Dojo while older classes operated on TEAMS. Students could return to school physically at any time. The E-learning facility allowed for flexibility which proved useful to students who needed to be quarantined during the course of the scholastic year.

Students in Grades 8, 9 and 10 in Senior School were asked to buy a touchscreen tablet with a detachable keyboard, a digital pen and a digitizer, to enable them to do their schoolwork, follow online sessions, and hand in homework, regardless of whether the students were physically at school or following from home. Students in Grade 11 and 12 were given the option of bringing their own devices from home.

Teachers scanned their booklets and were asked to create handouts and worksheets as editable PDFs.  These booklets and worksheets were made available on the students’ tablets, as soft copies, removing the need for purchasing them as hard copies.  This has the added benefits of a lighter school bag, and a reduced amount of printed material, which was also  part of the school’s conscious effort to be more environmentally friendly. The school is currently also looking into purchasing the licences of digital books, so as to have school books available online in the future.

Understanding that the tablets were an added expense during these fraught times, the school reached an agreement with the local Bank of Valletta, through which the tablets could be paid in monthly instalments. In order to facilitate matters, parents could pay though the school and not have to go through banks.

The school also invested in teachers’ resources. Teachers were provided with new laptops, which were compatible with the new interactive whiteboards that were installed during school closure. They were also given headsets to enable them to communicate with their students following lessons online, and graphical tablets were bought, to ease the marking of homework.

Physical presence and E-learning

The classes across the school were spacious enough to accommodate all children at a 1.5 metre distance.  Floors were clearly marked to ensure that all desks remain at this distance. Perspex was installed to separate students.

Teachers were given the option of either delivering live lessons, or using the flipped classroom approach wherein the recorded lessons or explanations were sent as homework and teachers would  be available online for the students during lesson time to help them with their work.

Safety

The objectives of the school were updated to include additional enhanced safety precautions to minimise the risk of COVID-19 spread. Public Health Advice was rigorously adhered to and adapted for the school and its opening with other schools in September 2020. This included maintaining a social distance of 1.5 metres between all persons in the school.  A log of everyday activities was kept throughout the scholastic year, as well as a log of the contacts of each and every child and staff member for contact tracing purposes.

School entry

A number of criteria for not attending school were also put in place. These included symptoms of COVID 19, a temperature above 37.2°C at school entrance, being in quarantine or in self-isolation, or having been in contact with a COVID-19 positive person within the last 14 days. If a household member travelled abroad to a country listed by public health as being in the red zone, students were required to remain at home for 15 days after the person returned from their trip. When students visited a red-zoned country, they were required to quarantine for 15 days  before returning to school.

Temperature-taking also took place before students boarded school transport. Temperatures above 37.2°C and children who looked visibly unwell were not allowed on school transport. Parents who transported their children to school were asked to check their children’s temperature before leaving home.

Students and staff members on antipyretics were not allowed to go to school under any circumstances. Staff members were equipped with a kit at the start of the scholastic year which included a visor, a reusable mask, hand sanitizer and antibacterial wipes.

All those entering the school were required to wear their own protective mask or visor and have their temperature checked. Children with temperatures above 37.2°C or with COVID-19 symptoms were referred to the nurse and kept in isolation until they were picked up within an hour. Staff at the door screening students upon entry were given a list of individuals who were required to present a COVID-19 free certificate upon their arrival.

Parents were asked not to crowd the public areas adjacent to the school. Students were to enter school immediately upon arrival, have their temperature checked, use hand sanitiser and proceed to their class and designated desk.

Perspex barriers were placed around desks of teachers and administration staff. Plastic curtains were installed except in nursery and grade 1, creating a protective barrier between the students in their bubble and the subject teachers who come in to deliver a lesson, thus creating a safe passageway.

Family measures

Before leaving home, families were asked to ensure that all materials brought to school had been wiped down, sanitised and contained in a single bag. Students were to bring material which was strictly needed for the day. Neither parents nor third parties were allowed into the school. Parents were asked to ensure that children had a clean mask and container to put the mask in whilst in class, as well as sanitizer, and tissues.  Parents were to wash cloth masks every day. Children were to bring their own hand sanitiser. Parents were told to remind children to wash their hands frequently at school, to avoid sharing anything with friends, to cough and sneeze into a tissue or elbow and to avoid touching their face, eyes, mouth and nose.

On return from school, parents were advised to remove their children’s uniforms immediately and to bathe or shower their children. This was then to be washed daily along with cloth masks. Students were given permission to wear their P.E. kit rather than their formal uniform, as it easier to clean. Parents were advised to wipe down all materials returned home, including school bags, shoes and books.

Social distancing

Two metre distancing markers were placed on the floor to remind students about social distancing. One-way traffic systems were enabled through the use of the main staircases and the fire escapes. Signs were placed strategically along the walls to remind students of these measures.

Masks

Both staff and students were expected to wear a face mask upon entry to school and on transport. Masks were to be worn at all times in corridors and common areas. Students in Early and Middle School were allowed to remove their masks in class. Students in Senior School were required to wear a mask at all times in the presence of all others.

Clinics

Three separate clinics were set up in Early/Middle and Senior School respectively. Entry to clinics required a mask.

First clinic – for minor injuries not related to COVID-19.

Second clinic – for those children who showed symptoms of COVID-19.

Third clinic – Isolation room for the children with COVID-19 symptoms. These children were to remain there until they were picked up by their parents.

Personal protective equipment (PPE) was also available for the Nurse or any member of staff in the case of a possible COVID-19 case.  PPE available included gloves, masks, visors, aprons and disposable gowns. Indeed, nurses were trained in the use of single use protective clothing.

Children taking regular medication were not sent to the school clinic for administration – the school nurse went around instead. All staff had been trained on how to deal with health and hygiene protocols and how to safeguard themselves and the students under their care.

Hygiene and ventilation

Door handles, stair rails, table tops, desktops, keyboards, and other surfaces were cleaned frequently during the day. All cleaning tasks were carried out with a mask and single use gloves. The school was cleaned twice a day with an additional deep cleaning at the end of each week.

Windows were kept open to maintain adequate ventilation. Air conditioning and heating was kept to a minimum and filters were regularly sanitised. 

Soft furnishings, soft toys and items which could not be easily cleaned and disinfected were banned from classrooms. Tables in Early School were changed in order to enable social distancing within the class.

Bathroom capacity was clearly marked on their entrances.  Areas where social distancing could not be maintained, such as sinks,  had Perspex dividers erected. Each class was allocated a bathroom to use. Teachers were also designated specific bathrooms for their use.

Children in quarantine/ill

Children in mandatory quarantine were only allowed back to school on the advice of public health authorities. When a child was noted to be ill, the teacher/LSE was asked to phone the nurse or the school management team (SMT), if the former could not be reached.  The symptoms were relayed and in obvious non-COVID cases, the nurse attended to the child in class or wherever the child happened to be, in order to avoid queues at the clinic. In potential COVID-19 cases, the nurse/SMT were instructed to wear personal protective equipment before going for the student in their classroom and the child would be taken to an isolation room to await pickup within one hour. The student was not allowed to enter the school without a negative COVID result and siblings were not allowed to return to school without public health affirmation.

Well Being

Counselling services were made available to all students. The purpose was to enhance the development of the student, to encourage personal growth, to empower them towards positive change and to see to their well-being. This service was available to individuals, groups or even a whole class. Counselling was also available indirectly through working with and supporting the parents/guardians.

Student counselling was  available for students in an acute crises or planned through a referral. As the service was in high demand, the students may have been placed on a waiting list, or referred to the Personal, Social and Career Development (PSCD) teacher. Phone calls, TEAMS, Skype, Zoom and WhatsApp were the main means used for communication and they also continued to function throughout the summer holidays. From September 2020, the service continued online or face-to-face.

Students were taught accurate and updated information about COVID-19.  Students were also regularly taught strategies to deal with anxiety and teachers were trained in mindfulness to teach students techniques to deal with fears and anxiety. 

Support groups were also organised for parents and children who stayed home due to vulnerability. Other support groups were available  for parents of children with specific needs.

Meeting staff

Meetings with members of staff were held by appointment online via agreed channels only.

Assemblies and mass activities

No physical assemblies were held in playgrounds due to social distancing issues. General assemblies were held twice weekly via TEAMS. All mass activities (Sports days etc.) were held in line with the guidelines issued by the Health authorities at the time. The library was closed; there was no book-borrowing and the library was instead used as a classroom. However, library sessions  still took place the same way as other subjects (see below). The use of the ‘Libby App’ , a free app that allows users to borrow eBooks and digital audiobooks from public libraries, was encouraged.

Alternate day start

Classes were split into two groups and these groups were asked to attend school on alternate days for the first few days. This was done to allow each group (group A and group B) to acclimatise. Siblings were asked to attend on the same days.

Drop off

Students were to exit school transport/cars wearing masks (students aged 3+) and walk straight to their respective main entrance. Nursery children were dropped off at the nursery gate. Nursery children, teachers and LSEs entered the school premises from the Nursery gate.

Students from Grade 2 to Grade 12 were dropped off in the car park where supervisors were present to take care of them and take them in. Grade 1, Grade 2 and Grade 3 students, teachers and LSEs entered the school premises from the main door of Early School. 

Grade 4 and 5 students, teachers and LSEs entered the school through the gate in the Grade 5 playground. Grade 6 and 7 students, teachers and LSEs entered the school through the playground gate next to the offices.

Leaving school

Middle school students going home with school vans were asked to wait outside school under the canopy.

Children picked up by parents and nursery children were picked up from the same place they were dropped off. Grades 1- 3 parents were asked to collect their children from their respective classes. Four parents at a time were allowed to enter school premises. Students in grade 4 to grade 7 were to remain in their respective classrooms and the exit procedure was coordinated by the supervisors. For Senior School, students were to remain in the class of their last lesson. For those taking school transport, van numbers were called out on the school PA system. A member of staff was present in each corridor to ensure that students left the classroom in an orderly manner, keeping appropriate social distancing. Students returning home with parents were to exit at staggered classroom intervals once school transport had left. Parents were required to be punctual and were advised not to linger on school premises once they had picked up their children.

Extra-Curricular Activities and Flexible Learning Programmes

No extra-curricular activities were offered except for religious catechism lessons which took take place online. Flexible Learning Programmes (FLO) took place within the same bubble of students and in the same class. Nursery teachers conducted these sessions for their respective classes.

Evacuation Procedures

Evacuation procedures remained unchanged but students were to be staggered once they reached the assembly points.

Corridor traffic

Corridor traffic was kept to a minimum, in order to ensure that all students remained within their bubble. Masks were to be worn in the corridors. No physical contact was allowed. Social distancing was followed by floor markings. Distancing markers were placed on the floor to remind students about social distancing.

Breaks

Breaks were staggered to avoid classes meeting in the playgrounds and in the corridors. A two-minute interval between the exit/entrance of one class and the next was set up. In case of bad weather, breaks were to take place indoors in the class’s respective common areas or in the classroom itself, as specifically timetabled. The staff room and canteen were available for use  with social distancing measures in place. The staffroom’s capacity was clearly marked at the entrance. Educators were given the option to purchase products from the canteen online and these were delivered to them. Similarly, students wishing to buy food from the canteen were to place an online order for any food that required cooking or preparation at the canteen, for first and second break. The food ordered was taken up to the students’ class by canteen personnel.  There was no seating available at the canteen. 

Delivery of the Curriculum

Internet (Wi-Fi) was provided by the school. All students were to remain in their respective class throughout the day. The number of children per class depended on the measures issued by the health authorities. Social distancing was respected at all times. All students had designated chairs and places could not be changed. In all classes, plastic curtains and Perspex dividers were installed to help with social distancing. No extra furniture in class apart from the teachers’ cupboards was allowed.

 ‘Full Class’ Scenario

In the event of a full class scenario, all students were required to come to school. The class teacher was responsible for helping students respect social distancing at all times. The class teacher was able to live stream or record if needed.

‘Digital Learning’ Scenario

In the event of digital learning, teachers were to conduct live sessions on TEAMS/Class Dojo. Small group online sessions and whole class online sessions took place each and every week depending on the age of the students. As for the younger grades, groups were split up into smaller numbers. A structured time-table was issued for all students to follow in case of digital learning or a flipped classroom approach.

The following procedures apply to the two scenarios mentioned above. All educators and all students were asked to have their camera on during all lessons. Free tech auditing was given to all teachers. A graphical tablet and a stylus pen were also given to all teachers and LSEs. Attendance was taken on a daily basis. Members of the school senior leadership team were included in every class on TEAMS.

Subject details

Students in Grade 10, 11 and 12 had core subjects, such as Maths, English, Maltese, Religion and Environmental studies delivered in their ‘home class’. Some movement of students occurred during option subjects, wherein part of the class left for a practical subject, whilst another group of students had their lesson delivered in the ‘home classroom’. Some students may simultaneously have listened to their option lesson online. Subject teachers carried out live sessions from their respective class and the students  followed the lesson from their main classroom.

The exceptions were Art, Home Economics, PE, Science and Drama.  Students sanitized their hands each time they entered and left a classroom. Students who did not follow regular lessons of Maltese but followed the Maltese as a Foreign Language programme (MFL), Italian students who followed the Italian Language and Culture course, and foreign students who had Module Sessions as an alternative learning programme to Maltese, had sessions in a separate classroom. Practical lessons, such as Chemistry, Physics, Biology and Science were held in the school laboratories.  Home Economics, Art, Computing and ICT were held in their designated classrooms. Students were required to wear masks during these sessions. PE and games were held outside, in the pitch and on the track, with appropriate social distancing measures.

Classes for PSCD, Art and Home Economics were divided into two groups and given sessions simultaneously in two separate rooms. Students remained in same class bubble but in smaller groups. Students taking Art, Design or Graphical were asked to get all their material as no sharing/borrowing was allowed. PSCD lessons were not broadcasted live but teachers were available for some individual sessions with the students if needed.. All work (except for practical subjects) was handed in to teachers as soft copies via TEAMS or One Note as requested.

Students who did not take Religion as a subject were asked to remain in their home classroom and to work from there, as there was no physical space for them to move elsewhere.  Grade 10 Students who did not take Maltese were  taken out of class during some of these lessons and had alternative lessons by different teachers.  Support teachers previously took children out of class in groups or offered support within the class.  This year, students were taken out individually and were  required to wear a mask during these sessions. 

Results

San Andrea had 11 COVID-19 cases between March 2020 and the time of writing (March 2021). Only one of these cases was via transmission within the school. Four were in Primary School (3-9 years of age) and seven were in Senior School (10-16 years of age). Public Health authorities tackled these cases differently.

The whole class and their family members were placed in mandatory quarantine in Primary School cases.  Teachers in these classes were also placed in quarantine given that they would have spent over 6 hours interacting with the children. 

In Senior school, students were only placed in quarantine if they were seated less than two metres away from the index case. Hardly any teachers were placed in mandatory quarantine since their time in each class did not usually exceed 1.5 hours. 

The school itself was proactive in that the school instantly and independently (from Public Health) also contacted all children and adults in contact with a positive case. Furthermore, although students were not necessarily in sufficiently close contact to mandate quarantine, the affected classes were still temporarily closed and students and their siblings followed school online.

Teachers in contact with a positive case were asked to stay home for at least five days and return to school after presenting a negative COVID swab test on the fifth day.

Any children who did not attend school for any reason were not allowed back to school without a medical note from their doctor. In the case of actual illness, they had to be symptom-free for 48 hours prior to returning to school. If children returned to school without a certificate, they were sent straight to the school nurse and the parents were called to pick them up.

Discussion

The number of children with active COVID-19 in Malta peaked on 03/03/2021, one week prior to the record number of total Malta daily cases of 510 on 10/03/2021. A partial lockdown was imposed which included school closures. In late March, over 260 children were infected with COVID-19 (10% of all active cases) and numbers started to decline slowly at most ages apart from the 0 to 5-year age group which remained constant. These continue to exhibit milder symptoms when compared to adults. It is thought that this paediatric upsurge was due to the so-called ‘UK variant’ (B.1.1.7) which is a highly transmissible strain.¹³

As cases declined,¹⁴ schools reopened after a one month partial lockdown and there have not been any new significant clusters attributed to schools. The administration of an effective paediatric COVID-19 vaccine should also facilitate this. The early observation in the course of the pandemic that children are much less likely to experience severe illness than adults remains true. However, this has created an incorrect perception that children are less susceptible to infection and do not play a substantial role in transmission.¹⁵

It is important to note that the role of children in transmission is not yet fully understood, although the relatively small number of outbreaks reported among teaching staff to date suggests that spread of COVID-19 within educational settings may be limited.¹⁶

Acknowledgments

We would like to thank all those who helped to create the working document on which this paper is based, i.e. school administration staff, Public Health colleagues and Education Department colleagues.¹⁷

References

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17. San Andrea School. COVID-19 Reopening Procedures, Scholastic Year 2020 – 2021. Mgarr; San Andrea School, 2020.

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