The reopening of schools in France is planned from May 11. Some countries have not closed their schools, others have already reopened them, some have decided to wait until the start of the school year in September and for some the debate is still ongoing.

These different situations bear witness to the diversity of contexts: living conditions, political organization, health system, school calendar, intensity of the epidemic, etc. They also illustrate the fact that political decisions in matters of public health cannot be based on simple, clear and definitive univocal data.

These decisions always involve a large set of parameters, and a degree of uncertainty. Indeed, even if it is a factor that today acts on health in a salient and obvious way for everyone, the Covid-19 epidemic is only one of the determinants of health among many others.

Research shows that the health of individuals and populations is influenced by a wide range of biological, socio-cultural, environmental, behavioral determinants linked to the health care system and that health inequalities are caused by these different factors.

For example, the decision to close schools leads to an increase in educational inequalities. The confinement conditions depend on the material conditions (access to a quiet space, to powerful digital tools in private spaces to practice physical activity) and to the relationship with the school maintained by the families, which is also strongly determined by socio-economic inequalities. Studies, including longitudinal studies, show that what is done outside of school (during ordinary holidays, confinement today) directly influences educational success, socio-economic status and therefore health [i].

While the social and educational determinants are not as visible, they nevertheless have a major impact. As Michael Marmot, Chairman of the WHO Commission on Determinants of Health, points out, inequality kills on a massive scale. The responses implemented thus depend on the priority given respectively to the short and long term challenges and to the consideration of the various determinants of health. In France, the government has arbitrated in favor of the reopening of schools and a differentiated deconfinement approach.

Beyond the political dimension, the question of the feasibility and the concrete modalities of the reopening is central . In a previous article , we looked at the available data on the policies to be implemented. Here we propose to focus on the concrete questions raised at the level of schools, colleges and high schools.

For this, we synthesized the questions that emerge from the side of parents and French education professionals and asked them to three school principals in Taiwan: a school principal, a principal of a college and the principal of a vocational high school.

We also took stock of the situation with researchers from the public health department of Fu Jen University in Taipei. The country reopened its schools on February 25, after having extended the winter holidays by two weeks. The school and establishment teams have two months of hindsight.

Compliance with barrier measures

Several prevention measures have been implemented depending on the establishment:

• body temperature measurement
• students, parents and staff wearing the mask on school transport and to school
• regular hand washing
• entrance checks

Wearing the mask in primary school was not a problem. The classrooms have been reorganized so as to have more space between the students and everyone, including adults, must sit in their own seat.

Parents are asked not to enter the school and to respect the social distancing measures around the school. If they nevertheless have to enter, they have to wear a mask, measure their body temperature, wash their hands and register by name at reception.

The measures differ depending on the size and type of establishment. In the college, the head teacher established the temperature measurement (front thermometer) at home before arriving at school, at the entrance and during lunch time. In the vocational school, the circulation and the groupings have been redesigned to avoid that too many people are in the same place at the same time.

With regard to the canteen, the situation is very different depending on the establishment, since meals can be taken in class or in the canteen as the case may be. When meals are taken in the canteen, strict measures are taken during the distribution of food (masks, gloves, headgear).

For school transport, compliance with the wearing of masks and social distancing has been facilitated by the fact that these measures are generalized to all public transport (train, bus, metro). The promotion of barrier gestures and positive behaviors by adults promotes respect for the rules by students and their vigilance.

The fact that the whole of society is in a position to fight the epidemic makes it possible for the establishment teams to enforce the barrier measures.

The implementation of these measures did not generate any particular difficulties due to both a precise national framework, the commitment of the whole social body and a wide margin of maneuver by the establishment teams to adapt the measures to the age of the children and the premises.

Conditions for success

In general, the managers of establishments stress that their action could be effective because of four key elements:

• upstream preparation via the health component of their establishment project
• a precise national framework, in particular on exclusion measures in the event of suspected Covid-19
• autonomy in the implementation of measures
• communication and ongoing support for teachers, parents and students

The directors and heads of establishments concerned relied on the health component of their establishment project and the team that runs it – the equivalent of “health education and citizenship committee” of French establishments. .

Their school, college or high school policy is based on a health promotion approach that includes six dimensions  : a plan based on an educational approach to health integrated into the school project, the physical environment of the school, relationships within the educational community, individual health skills, links with partners, school health services.

It is on this basis (health education policy, preexisting committee, experience) that schools and establishments built their strategy during the epidemic.

Heads of establishments also strongly insist on the issue of digital technology and distance education. For them, the priority is to make sure that the students have enough to work at home in the event of total or partial suspension of lessons. The challenge is to set up a sustainable hybrid system integrated into the health component of the establishment project, making it possible to deal with the epidemic over time.

Communication and support for students, parents and stakeholders in the educational community is a priority for the school leaders interviewed. These highlight the additional workload for professionals and insist on the need for very close support for the teams.

The same is true of families with whom there is intense communication. We must respond to parents’ concerns, explain what is expected of them … Although the procedures vary from one establishment to another, they use visual communication tools (posters, screens) and social networks. Chat groups are organized with teachers.

The difficulties identified concerned the provision of masks and means of prevention by the ministry, as well as the workload for the team in charge of health promotion and for teachers (barrier gestures for them, adaptation of teaching…).

The school, a health player

The issues faced by Taiwanese school heads differ little from those of their French counterparts. Even if you have to be very careful in comparisons, their experience can be instructive.

The salient elements relate first of all to the integration of the problem of managing the Covid-19 crisis into an educational vision of health beyond just medical issues. The approach concerns both the establishment as a place of life and as a privileged space for education. The management of an epidemic is one element among others of the action in favor of the health of the pupils which concerns at the same time protection, prevention and health education.

All measures are designed with reference to student development and citizenship. In France, we also have the tools enabling schools and educational establishments to implement a sustainable health promotion approach and thus to integrate the measures taken during the epidemic into a structuring framework .

It is then the balance between a national framework and the guarantee of having dedicated means (masks in particular), on the one hand, and the autonomy necessary to adapt to the context and the needs of the students on the other.

It is also the link between school and society. The school heads emphasize the fact that compliance with the barrier measures is made possible by the social context (in particular the wearing of masks in transport). The school is not a magic wand and it is advisable not to send back to the establishments more responsibilities than they can assume.

We can recall here that without clear communication with parents, they resist the idea of ​​sending their children to school. It is enough to be convinced to follow the Facebook group entitled “My child should not be a guinea pig for Covid-19” “My child should not be a guinea pig for the Covid-19” that have already joined more than 40 000 people in Denmark. All of society is involved in the fight against the epidemic and the school contributes to it in reference to its central mission of educating everyone.

This example highlights the fact that the central issue is above all to ensure that school health issues are dealt with from an academic point of view, with reference to the education of students. School as a key player in the health of all via the living conditions it offers to students and the education it provides, not just a public health tool.

Author Bio: Didier Jourdan is Professor, holder of the UNESCO chair and WHO collaborating center for Global Health & Education at the Université Clermont Auvergne