Dr Mike Bedford: Restrict childcare to essential workers' children first

Opinion

COMMENT

If early childhood centres open under current regulations they could pose the greatest risk of a point-source Covid-19 outbreak in New Zealand – greater than the 20-30 year age group, schools, rest homes or in-store retail.

The in-centre risk is especially high for teachers, who cannot effectively protect themselves.

Children are not immune, and can be carriers. Early childhood education (ECE) centres have routinely produced community-wide viral outbreaks. It's important to realise that approximately 230,000 children and staff are in the ECE sector. We need to protect our children, teachers, families and communities.

The Ministry of Education will be under some pressure (community and commercial) to reopen centres.

While I so much feel for parents who will be struggling with work from home with their children, we risk undoing the sacrifices made by New Zealanders when we moved to level 4.

As Education Minister Chris Hipkins has said, it doesn't work neatly in reverse. A return to a level 3 or level 2 scenario doesn't mean that we can automatically have ECE centres re-opening.

If we return to the previous regulatory environment it could easily result in very rapid spread of Covid-19 across 100 or more families, and across an area of 5km radius or more from just one child, in one centre. If this happens, we will go backwards.

It is very important that while we still have community transmission risk, we limit attendance to essential needs only, and we must have much better provision for space per child, teacher/child ratios and group size.

The reasons for this risk are easy for us to see. ECE environments normally include all of the major risks for Covid-19 transmission.

Social distancing is impossible. Children need to be held, need to have cuddles, and play close to each other.

Children in ECE can be at an age where they are constantly touching and mouthing surfaces and objects, with surface contamination from oral and nasal secretions. Let's face it – goo is normal. ECE centres have proven very effective at producing point-source outbreaks with rapid community spread.

But that's not all. In New Zealand the situation is made much worse by our very poor regulations. As a result, many of these environments have been seriously overcrowded, and have inadequate hand-washing facilities.

There have often been too few teachers to properly care for the children – and that's on a normal day. Stress levels have already been very high in many centres.

We have crowded sleep rooms with poor ventilation, or sometimes no ventilation. We have poor heating systems, and this is likely to increase viral survival times on surfaces.

So what do we need to do?

If any centre-based childcare or other ECE such as kindergarten is to open in level 3, it must be for essential needs only, for parents who need this service in order to work. All other children must stay home until other adjustments can be made, adequate for a level 2 situation.

We need special provisions to override the Education (Early Childhood Services) Regulations. These regulations were in desperate need of change, but they are simply dangerous in the current environment.

1. While community transfer is continuing, do not provide centre-based ECE and care except for those parents for whom it is essential.

2. Reduce child/teacher ratios from the current 5:1 for children under 2 to a maximum of 3:1 for children under 3, and from 10:1 to 5:1 for children over 3.

3. Manage situations to limit group size to no more than three times the child/teacher ratio (maximum child group size 9-15). Group size is difficult to manage , but may be defined as children and teachers mixing closer than two metres apart. This is to help reduce short-term infection cluster size.

4. Stagger sleep times to reduce crowding and maintain group size limits. Don't use unventilated sleep rooms.

5. Children and staff to all wash hands or use alcohol-based sanitiser on arrival, and before leaving the centre.

6. Any child or staff member with Covid-19 related symptoms who might otherwise have attended, to stay away, and as a priority, to be tested for Covid-19.

7. If children can't be accommodated at their usual centre, priority should go to children under 2 to stay with their usual teachers. This is important to avoid disruption of essential child-to-teacher attachment relationships in that age group.

We can do all of this if we have fewer children attending, or children attending for fewer hours.

There is a silver lining to a difficult situation

As we move to a post Covid-19 environment, we face the prospect of high unemployment. Many people may find themselves working part-time – which is better than no job at all.

Dr Mike Bedford warns that reopening early childhood centres needs to be managed carefully. Photo / Supplied

This is hard, but we can grab the opportunity to move much more rapidly towards improved conditions for children and teachers, especially in centre-based ECE and care, in line with regulatory improvements already recommended for children's health and learning.

There is an opportunity, via part-time work and job sharing, to move to an emphasis on quality of life. We can have higher quality ECE environments, and we can make better use of sessional ECE and parent-led ECE such as Playcentre, with more family and community time in early years. We can have better space per child, better teacher/child ratios, smaller group size, and shorter hours more related to educational purposes.

Before Covid-19, New Zealand was headed towards a collapse of the ECE sector in the next term of government, as many teachers left because of the terrible conditions they and the children were being subjected to. This wasn't the case everywhere – some centres have been beautiful, and definitely very good for children, but too many were not.

Covid-19 has forced us to recognise unpleasant realities. New Zealand has done so well, and we can still do well. Now is the time to recognise our new reality and make the best of it for everyone, especially our children.

• Dr Mike Bedford is the only post-graduate public health qualified expert in ECE health in NZ, with nearly three decades ECE sector experience. He has personally investigated some 50 ECE and community outbreaks, especially viral outbreaks. He is an advocate for high quality early childhood education. He can be contacted at mike.bedford@rockpool.nz