What actions should schools take to reduce transmission of COVID-19?
Evidence suggests that children are at a lower risk of contracting COVID-19 than adults and even when they do contract the virus, their symptoms are generally more mild. However, children are still susceptible to infection and are potential transmitters of the virus and degree of susceptibility and transmission varies with age. Throughout the pandemic, COVID-19 outbreaks have been reported in schools, day care centres and summer camps. Preventing the spread of COVID-19 among children is important to protect both the health of the children and to slow transmission of COVID-19 in communities, particularly among older people and individuals with existing medical conditions.
At the start of the pandemic, school closures were among the first actions by governments around the world to prevent the spread of COVID-19. Schools should follow national and local guidelines advising when it is safe to re-open. UNESCO, UNICEF, the World Food Program, and the World Bank have published a framework for reopening schools, which provides re-opening guidance and recommendations for national and local stakeholders. The Pan American Health Organisation (PAHO) has also published guidance on school-related public health measures, with a focus on groups who might be vulnerable to exclusion and discrimination. The WHOs report on COVID-19 infection prevention and control (IPC) also includes guidance for schools. Ensuring the physical protection of students, teachers, and school staff – including access to a hygienic environment and access to handwashing facilities – is an essential precondition for re-opening.
There are three key goals that need to be achieved for schools to contribute to COVID-19 reduction:
Reducing person-to-person transmission
Reducing contact exposure
Ensuring students and school staff with key COVID-19 symptoms (or those in close contact with symptomatic individuals) stay at home, and supporting national policies on testing, contact tracing and isolating.
We discuss strategies to achieve each of these goals below. Recommendations are based on guidance on the prevention and control of COVID-19 in schools published by UNICEF, WHO and IFRC and by the WHO. The Global Education Cluster’s practitioner’s guide to safely reopening schools provides more detailed guidelines and checklists for reopening, and addresses a range of school-specific issues, including education, nutrition, child protection, mental health, and adapting approaches to camp settings. The WHO’s report on schooling during COVID-19 and their checklist to support schools re-opening also offer further guidance. For an in-depth example of a COVID-19 response programme for the safe re-opening of schools, see this case study from UNICEF’s work in Indonesia.
How can person-to-person transmission be reduced in schools?
Reducing person-to-person transmission requires:
Promoting physical distancing
Promoting good respiratory hygiene practices
Improving hand hygiene behaviours
A. Promoting physical distancing
Schools should adhere to national and local guidelines on physical distancing in schools. There are several broad strategies to promote physical distancing, including:
Visual cues that support spacing of greater than 1 metre (3 feet) (or distance advised by national government, if different)
Reducing density of the buildings and campus
Closing or restricting gathering spaces.
For example, in contexts experiencing COVID-19 outbreaks where schools are open, the following measures may be considered as part of these strategies to create safer environments:
Staggering the beginning and end of the school day, so that all pupils do not need to be present at the same time
Cancelling assemblies, sports games and other events that create crowded conditions
Holding breaks in shifts, to avoid overcrowding in corridors and playgrounds
Moving lessons outside if feasible, or ventilating rooms as much as possible
Demarcating playgrounds into zones, to ensure pupils do not mix more than necessary
Placing marks on the floor, to cue children to stand the correct distance apart while waiting to enter a room, for example painting colourful circles 1 metre apart (or distance advised in national guidelines) in the corridor (see above image for example)
Introducing one-way systems for moving through buildings
Creating space for children’s desks to be at least 1 metre apart (or distance advised in national guidelines)
Installing desk-top partition/divider screens
Reducing pupil-to-teacher ratios, by increasing the number of teachers, if possible, to allow for fewer students per classroom (if space is available)
Advising against crowding during school pick-up
Ensuring only 1 child per seat on school buses and that they are at least 1 metre apart (or distance advised in national guidelines), if possible. This may require increasing the number of school buses per school. Keep windows on the bus open, if possible
Creating awareness to ensure the students do not gather and socialise when leaving the school and in their free time
Adhering to physical distancing is just as important for adults working in the school as it is for the students. Teachers should model and teach correct physical distancing behaviours.
B. Promoting good respiratory hygiene practices
Children should be encouraged to cover their mouth and nose with their bent elbow or tissue when coughing or sneezing and to dispose of used tissue immediately. These messages should be incorporated into the curriculum, alongside broader hygiene promotion – refer to the section below, entitled ‘Sharing age-appropriate COVID-19 information with children’.
The use of face masks or face coverings in schools should be in line with local and national guidelines. Decision makers can refer to WHO advice when developing national and local policies on the use of face masks/coverings among children in the context of COVID-19. Their most recent IPC guidelines published in January 2023 strongly advise that children 12 years and above follow the same mask recommendations as adults. The benefits of mask-wearing among children for COVID-19 control should be weighed against potential harm associated with wearing masks, including feasibility and discomfort, as well as social and communication concerns, and when adapting these policies specifically for schools, the views of teachers and educators on the perception of risks and the time burden required to ensure adherence to COVID-19 policies in schools and classrooms should be considered.
Where masks are advised in schools, sufficient supply of appropriate masks should be ensured for all school children and care should be taken to ensure masks are used safely. For more information on types of masks and how to use them safely, see our resource ‘Summary report on masks and COVID-19’. If wearing fabric masks is advised, specific instructions and supplies should be provided for the safe storage, handling and availability of fabric masks. If medical or disposable masks are advised, a system for waste management, including disposal of used masks, will need to be established to reduce the risk of contaminated masks being disposed of in classrooms and playgrounds.
Note that it is advised that children aged up to five years should not wear face masks. If national or local policies recommend a lower cut off age, appropriate and consistent supervision, including direct line of sight supervision by a competent adult and compliance, need to be ensured. It is also important that the age cut-off for wearing a mask is adapted to school settings, to avoid stigmatizing and alienating children in mixed-aged groups where individuals may be on opposite sides of a recommended age cut-off. For example, in situations where older children for whom masks are advised are in the same class as younger children who fall below the age cut-off for wearing masks, the older learners might be exempt from wearing masks.
Children with severe cognitive or respiratory impairments who have difficulties tolerating a mask should, under no circumstances, be required to wear a mask. For children of any age with any other developmental disorders, disabilities or other specific health conditions that might interfere with mask wearing, the use of masks should not be mandatory and should be assessed on a case by case basis by the child’s educator and/or medical provider. No child should be denied access to education because of mask wearing or the lack of a mask, due to low resources or unavailability.
The use of masks by children and adolescents in schools should only be considered as one part of a comprehensive strategy to limit the spread of COVID-19.
C. Improving hand hygiene behaviours
There are a range of ways to improve handwashing behaviours. Below we describe how you can create an enabling environment, how to cue handwashing behaviour, how to incorporate hygiene promotion into the curriculum and how to create a schedule for frequent handwashing.
Create an enabling environment: Schools must enable good hygiene practices. To do this, schools should have:
Handwashing facilities with both soap and water available at all times (See JMP requirements for basic hand hygiene facilities in school settings).
Handwashing facilities that are accessible to all users and that consider different needs based on the student’s age, gender and disability.
Water available through on-site taps, boreholes or from a reservoir with containers that are cleaned and filled regularly.
An adequate quantity of safe water to allow for personal hygiene practices including handwashing and menstrual hygiene management, as well as for environmental cleaning.
Handwashing stations with soap and water, or alcohol-based handrub dispensers (with between 60%-80% alcohol) should be available:
Near every toilet or bathroom, to enable handwashing after using the toilet.
At the lunchroom entrance, to enable handwashing before eating.
At school entrances, to encourage students to wash hands with soap on arrival at school and upon departure.
At the entrance of every classroom (if possible).
In dormitories (where applicable).
In food preparation areas (where applicable).
Make changes to the environment to cue handwashing: Changes can be made to the physical environment to help remind students and cue handwashing behaviour. These changes can be termed ‘environmental nudges’. This guide from the WASH in Schools Network (WinS) presents a select number of nudge-based interventions. We summarise some of these interventions here:
Painting colourful footprints that lead children from the toilet to the handwashing facility and handprints on the facility, as a reminder to use it. One study in a school in Bangladesh showed that this nudge increased children's handwashing behaviour by 64%. In a subsequent cluster-randomised controlled trial, this footpath nudge was compared to a high-intensity education-based intervention and was found to be equally effective at the 5- month follow-up.
Source: Dreibelbis et al (2016)
Placing an image of eyes above handwashing facilities to give the sense that others are watching and expect to see handwashing. One study in a women’s public restroom found people were 10% more likely to wash hands in the presence of these eyes.
Source: Biran et al (2014)
2. Using soaps with toys embedded inside to draw children’s attention and incentivise them to wash their hands with soap frequently, in order to reach the reward. A controlled study in a displacement camp in Iraq, found that putting toys in soap made children 4 times more likely to wash their hands with soap in the household.
3. Placing pictures of germs on surfaces that many people touch, such as toilet door handle, to induce a sense of disgust after touching these surfaces and subsequently cue handwashing.
4. Placing mirrors above handwashing stations to make handwashing more desirable and encourage longer handwashing.
Source: Engineering for Change
5. Drawing attention to the soap dispenser or handwashing station with bright colours
How to teach hand hygiene at school on Global Handwashing Day by Paul Jakeway. Source: DEB Blog
6. A Study in the Philippines targeting COVID-19 found that introducing a series of nudges, including a footpath to the sink with “watching eye” stickers and arrows to the soap dish, increased rates of handwashing with soap after using the toilet by 17%.
Include hygiene promotion as part of the curriculum: Hygiene promotion should be part of the school curriculum. Content should be age-, gender-, ethnicity- and disability-responsive. For more information on how to include hygiene promotion for different age groups (pre-school, primary school, and secondary school), refer to the section below, entitled ‘Sharing age-appropriate COVID-19 information with children’.
Create a schedule for frequent hand hygiene, especially for young children: Frequent hand hygiene should be established by scheduling times for handwashing sessions supervised by teachers or other school staff. For example, students may be asked to wash their hands hourly.
How can we reduce surface related transmission of COVID-19 in schools?
Though the primary route of COVID-19 transmission is via direct contact with an infected patient, and the relative risk is low, individuals can also be indirectly infected via contact with surfaces in the immediate environment, or with objects used by an infected person.
Reducing contact transmission (such as on surfaces) requires:
A. Extensive cleaning and maintenance of facilities
B. Reducing high-touch surfaces
A. Extensive cleaning and maintenance of facilities
Surfaces and laundry (when applicable) in all environments where students, teachers and non-teaching staff spend time (classroom, dining areas, playrooms, staff rooms, dormitories, laboratories) should be cleaned and disinfected at least once a day. This is particularly important for water and sanitation facilities and other surfaces that are touched by many people (high-touch surfaces), such as tap handles, railings, lunch tables, sports equipment, door and window handles, toys, and teaching and learning aids.
The World Health Organisation recommends that surfaces are always cleaned with soap and water or a detergent, to remove organic matter first, followed by disinfection. In school settings, sodium hypochlorite (bleach) may be used at a recommended concentration of 0.1%. Alternatively, alcohol with 70%-90% concentration may be used for surface disinfection, an option which may be more suitable for cleaning small objects. Where disinfectants are being prepared and used, the minimum recommended personal protective equipment (PPE) is rubber gloves, impermeable aprons and closed shoes. For more detailed information on disinfection of surfaces and laundry, see our resource.
Trash should be removed daily and safely disposed, and airflow and ventilation should be maximised where climate allows, for example, by opening windows or using air conditioning where available.
An operation and maintenance routine should be established to ensure cleanliness and functionality of facilities and provision of consumables. If soap is available and facilities are functional and clean, teachers’ messages around hygiene may be more credibly conveyed. Cleaning items such as commercial detergents, mops, buckets, and basic PPE (to the extent possible) should be provided for use by cleaning staff in schools. Schools should regularly assess their water, sanitation and hygiene (WASH) environment and endeavour to make improvements in manageable steps. The complete UNICEF guidelines for WASH in schools can be found here.
Various members of the school community – including management committees, teachers, janitors, cleaning staff, school health staff, and students – can help in efforts to improve a school’s WASH environment. Key roles should be identified and assigned. The WHO offers advice on assigning roles to members of the school community (Annex 1).
A school’s community does not stop at the school itself. Parents, technical experts and community leaders can help identify problems and develop solutions, as well as provide additional funding and support implementation. Tips for engaging the wider community can also be found in the WHO guide, mentioned above. Leaders of the school management committee should take overall responsibility for ensuring members of the school community play their role accordingly. Available evidence supports this whole-community approach to improving and maintaining facilities: studies have found that upfront local involvement, community financial support, a local champion, a maintenance plan, school management committee involvement, and giving students responsibility for monitoring and cleaning school latrines are all key factors on the pathway to well-managed school WASH facilities.
B. Reducing high-touch surfaces
Where possible, school administration may consider removing or modifying high-touch surfaces, such as communal furniture, toys, and sports equipment. This may also include propping open doors to minimise contact with door handles. The remaining high-touch surfaces should be identified for priority disinfection and cleaned at least once daily.
How can schools ensure students and staff with COVID-19 symptoms stay at home and follow national policies on testing, contact tracing and isolating?
To support national policies on testing, contact tracing and isolating, schools should be in communication with local health authorities. Where local policies stipulate, school administration should notify health officials of positive COVID-19 cases identified within the school community. Schools should keep parents and teachers informed about the measures the school is putting in place and ask for their cooperation – inclusive and early collaboration between the school and the community is needed to develop and implement necessary measures.
While schools may not have the capacity to conduct tests themselves, they should do the following:
Encourage students, teachers, and other school staff with key symptoms like cough and fever, to stay home and get tested if possible. Schools may decide to conduct temperature checks on those entering the school building. In the event that symptoms are identified during school hours, a procedure should be in place for separating sick students and staff from those who are well – without causing stigma – and for informing parents/caregivers and consulting with health care providers/health authorities, wherever possible. Students/staff may need to be referred directly to a health facility, depending on the situation, or sent home.
Encourage students, teachers and other school staff with a family member showing symptoms to stay home and get tested if possible. Reinforce that caregivers should alert the school and health care authorities if someone in their home has been diagnosed with COVID-19, and should keep their child at home for 10 days after the onset of symptoms in the patient. Flexible attendance and sick leave policies should be in place, that encourage students and staff to stay home when sick or when caring for sick family members.
Ensure that students, teachers, and other school staff who test positive for COVID-19 relay school contacts, and advise that these contacts should stay home or get tested (if possible).
Monitor absence daily. If higher-than-usual absence amongst students and teachers is noticed, inform health authorities immediately.
Guidance should be clearly communicated to children and family members in the appropriate local language, including pictorially if literacy levels are low.
How can schools share age-appropriate information on COVID-19?
To achieve the goals described above, children and young people should understand basic, age-appropriate information about coronavirus disease (COVID-19), including its symptoms, complications, and how it is transmitted and prevented. Activities should be contextualised further, based on the specific needs of children (language, ability, gender, etc). Information should be shared in a fun and interactive way and repeated periodically. Below are the guidelines from UNICEF, WHO and IFRC on the information and activities that can be shared with children in different age groups. For ready-to-use resources, the WASH in Schools Network has compiled a knowledge map with links to relevant materials (e.g. songs, videos, activities, and information sheets) about COVID-19 for learners, their families and the education system.
Preschool (approximately age 2-5)
Children in this age group are rapidly expanding their language, social-emotional and cognitive skills and learn best through play, exploration and hands-on learning. Use stimulating activities and materials to share COVID-19-related messages with preschool-age children:
Focus on teaching young children good health behaviours, such as covering coughs and sneezes with the elbow and washing hands with soap frequently.
Sing a song while washing hands to practice the recommended 20 second duration. Children can also practice washing their hands with hand sanitiser if this is something that is available in the local context.
Develop a way to track handwashing and reward frequent and timely handwashing. For example, try creating a handwashing sticker chart or giving certificates to students who are practicing good handwashing. Teachers should ensure that rewards are suitable for the local context.
Use puppets or dolls to teach good health behaviours, to demonstrate symptoms (sneezing, coughing, fever) and what to do if feeling sick, and how to comfort someone who is sick (cultivating empathy and safe caring behaviours). There are many videos available online demonstrating how to make puppets such as this one.
Use story books such as this, to teach children about the virus and why we need to practice good health behaviours.
Have children sit further apart from one another, have them practice stretching their arms out or ‘flapping their wings’, they should keep enough space to not touch their friends.
Primary school (approximately age 5-12)
Play-based learning is important for children in primary school. Fun, interactive opportunities enhance children’s mastery of taught concepts and build motivation to learn. Use interactive activities and stimulating materials to share COVID-19-related messages with primary school children:
Listen to children’s concerns and answer their questions in an age-appropriate manner; don’t overwhelm them with too much information. Encourage them to express and communicate their feelings.
Emphasize that children can do a lot to keep themselves and others safe. For example, introduce the concept of physical distancing (standing further away from friends, avoiding large crowds, not touching people if you don’t need to, etc.). Focus on good health behaviours, such as covering coughs and sneezes with the elbow and washing hands with soap.
Give children illustrated books such as this, to share messages about COVID-19 and how to control it.
Help children understand the basic concepts of disease prevention and control. For instance, use exercises that demonstrate how germs can spread. For example, by putting coloured water in a spray bottle and spraying over a piece of white paper, observing how far the droplets travel.
Sing a song while washing hands to practice the correct procedure for the recommended 20-second duration, as done in this study.
Demonstrate why it is important to wash hands for 20 seconds with soap and water using fun, interactive activities. For example, put a small amount of Vaseline on students’ hands and then sprinkle some glitter on top representing the virus. Have them wash them with just water, notice how much glitter remains, then have them wash for 20 seconds with soap and water. See a demonstration of this activity here. This activity can also be done with water-based paint instead of glitter. To also demonstrate how easily the virus spreads, have children touch frequently-touched surfaces, such as door handles, to see how the glitter/paint remains. Alternatively, put some ground black pepper (virus particles) into a bowl of water and ask a child to dip their finger into the “virus water”. When the child takes their finger out of the water, it has specks of pepper attached to it, representing “the virus”. Ask the child to then put some soap on their finger before dipping it back into the bowl of pepper and observe how the pepper rapidly moves away from the soap-covered finger. See a demonstration of this activity here. This activity also works with glitter and a toothpick.
Source: Restoration Place
Have students analyse texts to identify high risk behaviours and suggest modifying behaviours. For example, a teacher comes to school with a cold. He sneezes and covers it with his hand. He shakes hands with a colleague. He wipes his hands after with a handkerchief then goes to class to teach. What did the teacher do that was risky? What should he have done instead?
Use storytelling to convey important information, such as COVID-19 symptoms, transmission and preventive behaviours, in a fun and accessible way, as done in this study.
Secondary school (approximately ages 12-18)
Children in this age group learn best via interpersonal approaches, involving activities like discussion, group work and interaction with other students. Teaching related to COVID-19 should build on their prior knowledge and experiences:
Make sure to listen to students’ concerns and answer their questions.
Emphasize that students can do a lot to keep themselves and others safe. For example, introduce the concept of physical distancing. Also focus on good health behaviours, such as covering coughs and sneezes with the elbow and washing hands with soap. Remind students that they can model healthy behaviours for their families, for example, practising good health washing at home and reminding and encouraging their families to do the same.
Encourage students to confront and prevent social stigma related to COVID-19 (i.e. labelling, stereotyping, discriminating against someone or a group of people because of a perceived link with the disease). For example, discuss the different reactions they may experience around discrimination. Encourage them to express and communicate their feelings but also explain that fear and stigma make a difficult situation worse. Teach them that using language that perpetuates existing stereotypes can drive people away from taking the actions they need to protect themselves.
Build students’ agency and have them promote facts about public health. For example, have students make their own Public Service Announcements through school announcements and posters, or encourage already existing student leadership bodies to spearhead sharing messages related to COVID-19 in their schools.
Incorporate relevant health education into other subjects. For example, science classes can cover the study of viruses, disease transmission and the importance of vaccinations. Social studies can focus on the history of pandemics and evolution of policies on public health and safety. This can also include the role of various stakeholders, including local leaders and the students in the fight against the COVID-19 pandemic. Media literacy lessons can empower students to be critical thinkers and makers, effective communicators and active citizens. Literacy studies can encourage students to contribute to community actions, for example, writing letters to members of the community who might be vulnerable to exclusion and discrimination during this time and joining local organisations in carrying out COVID-19 awareness campaigns.
What actions should be taken for vaccination of children against COVID-19?
Trials have demonstrated that COVID-19 vaccines are safe in children and adolescents, however, the direct health benefit is lower relative to vaccinating adults. The WHO currently advises immunizing children who have comorbidities or are immunocompromised. They also advise that the decision to vaccinate the rest of the child and adolescent population must consider the prioritisation of providing key groups (e.g. older people and people with existing health conditions) and adults with vaccines and boosters. For more information on COVID-19 vaccines, see our resource.
Written by: Julie Watson
Last updated: 03.06.2023