This document provides strategies for safely reopening schools during the COVID-19 pandemic. It discusses the importance of reopening schools while ensuring safety. A community-centered approach is recommended that engages all stakeholders, including building a national school health network and developing comprehensive safe school health services. Guidelines are provided around learning models, social distancing, masks, hygiene, and establishing school-based health centers with referral systems to safely support student and staff health during the pandemic.

1. #Back2SchoolHealth
Strategies to Reopen Schools
…learning in a safe environment.
Abbreviations.
CASEL: Collaborative for Social and Emotional Learning.
COVID-19: Coronavirus Disease 2019.
EiEWG: Education in Emergencies Working Group.
NCDC: Nigerian Centre for Disease Control.
PHEIC: Public Health Emergency of International Concern
SEL: Social and Emotional Learning.
UNICEF: United Nations Children's Educational Fund
WHO: World Health Organization.
Dedication
This Paper is dedicated to the Memory of Mrs. Theresa
Kofoworola Osibamowo​. A Woman of Multiple Substances who
through consistent focus, determination, quest for excellence and an
undying spirit built impact-driven families across three-generations,
three-continents and multiple industries. ​Sun Re O Mama Efunbo.
You will never be forgotten!
Acknowledgements.
My gratitude goes to my indefatigable boss Dr. Efunbo Dosekun who
initiated me to the concept of School Health and who has
continuously nurtured my spirit even up till this day, my Strategic
Partner Seyi Adebanjo with whom I banter most of the concepts in
this paper (and we are even yet to agree on many), the Management
Team of Outreach Group with whom a lot of the experiments that
birthed this concepts were conducted, my family who supported my

2. late nights doing the research, and finally and most importantly the
Almighty God for giving me the Grace.
Dr. Segun Ebitanmi,
segunebit@gmail.com
+234 806 764 4530.
September 2019.
Introduction.
The Director General of the World Health Organization (WHO)
declared the outbreak of the coronavirus disease 2019 (COVID-19) on
30th January 2020 a Public Health Emergency of International Concern
(PHEIC). On 27th February 2020 the Federal Ministry of Health
announced the confirmation of the first case of Corona virus disease in
Lagos State, Nigeria. In the same communication the Honourable
Minister of Health announced that the Multi-sectoral Coronavirus
Preparedness Group led by the Nigeria Center for Disease Control
(NCDC) and immediately activated its National Emergency operations
Center. On March 19th, 2020 a circular from the Federal Ministry of
Education granted approval for the closure of all schools for a period of
one (1) month commencing from Monday 23rd March 2020 to prevent
the spread of the Coronavirus (COVID-19). Each State in Nigeria has
contextualised this circular. The closure of schools affects close to 46
million students throughout the country.
https://reliefweb.int/sites/reliefweb.int/files/resources/nigeria_education
_sector_covid-19_response_strategy_north_east_.pdf

3. Why reopen schools?
Disruptions to instructional time in the classroom can have a severe
impact on a child’s ability to learn. The longer marginalized children
are out of school, the less likely they are to return. Children from the
poorest households are already almost five times more likely to be out
of primary school than those from the richest. Being out of school also
increases the risk of teenage pregnancy, sexual exploitation, child
marriage, violence and other threats. Further, prolonged closures
disrupt essential school-based services such as immunization, school
feeding, and mental health and psychosocial support, and can cause
stress and anxiety due to the loss of peer interaction and disrupted
routines. These negative impacts will be significantly higher for
marginalized children, such as those living in countries affected by
conflict and other protracted crises, migrants, refugees and the forcibly
displaced, minorities, children living with disabilities, and children
in institutions. School reopenings must be safe and consistent
with each country’s overall COVID-19 health response, with all
reasonable measures taken to protect students, staff, teachers and their
families.
https://unesdoc.unesco.org/ark:/48223/pf0000373348
We also know that, for many students, long breaks from in-person
education are harmful to student learning. For example, the effects of
summer breaks from in-person schooling on academic progress, known
as “summer slide,” are also well-documented in the literature.
According to the Northwest Evaluation Association, in the summer
following third grade, students lose nearly 20 percent of their
school-year gains in reading and 27 percent of their school-year gains
in math.​[14]​ By the summer after seventh grade, students lose on
average 39 percent of their school-year gains in reading and 50 percent

4. of their school-year gains in math. This indicates that learning losses
are large and become even more severe as a student progresses through
school. The prospect of losing several months of schooling, compared
to the few weeks of summer vacation, due to school closure likely only
makes the learning loss even more severe.
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childc
are/reopening-schools.html
This means that in the minimum of Six Months that these children will
have been at home by the time of resumption, they will have lost over
60% of their knowledge.
Schools play a critical role in supporting the whole child, not just their
academic achievement. In addition to a structure for learning, schools
provide a stable and secure environment for developing social skills
and peer relationships. Social interaction at school among children in
Primary School is particularly important for the development of
language, communication, social, emotional, and interpersonal skills.
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childc
are/reopening-schools.html
The dilemma of parents who must pay more to employ nannies to
chaperone out-of-school children when their incomes have stagnated
(or even depreciated) due to the pandemic is very evident.
The case for a quick, safe and secured return of children to schools
cannot be over-emphasized.

5. On the other hand, there are reported cases of severe manifestations of
the COVID19 in children and as such the common notion that
COVID19 does not affect children has been effectively dispelled.
"Recent evidence suggests that children likely have the same or higher
viral loads in their nasopharynx compared with adults and that children
can spread the virus effectively in households and camp settings," the
guidance states.
Transmission of the virus to and among children may have been
reduced in spring and early summer due to mitigation measures like
stay-at-home orders and school closures, the CDC says.
https://edition.cnn.com/2020/08/15/health/us-coronavirus-saturday/inde
x.html
Juxtapose this with the fact that even if children generally do not come
down with the severe form of COVID19 as commonly as adults, the
school community is made up of ADULTS (and even elderly) teachers
and administrators who may bear the brunt of getting infected from an
asymptomatic child that carries the virus to school. This is not to forget
that children have ADULT parents who interact closely with these
children and can become the final victim of an asymptomatic
COVID-19 carrier.
Therefore, despite the need for a swift return to school of the children,
an improperly planned (and prepared) return to school can lead to a
disaster of unimaginable proportions.
Re-opening schools and learning centres therefore requires a very
careful, painstaking, meticulous and comprehensive process that
involves among others;

6. A. An immersive and synergistic engagement of ALL stakeholders
in the school community (including pupils/students, teachers,
administrators, parents, service providers, and regulators) to build
capacity for a School Health ​“Community Centred Care”​;
B. Building of a ​National School Health Network (mediNet)​.
C. The Development of a Comprehensive, Responsive and ​Safe
School Health Service​.
#Back2SchoolHealth​ will try to provide a framework that takes cognizance
of these detailed guidelines and endeavors to recommend practices that
implements all elements of an effective Back to School Strategy with the
intention of guiding all members of the school health community on a safe
and effective return to school of the children.
Community - Centred Care​.
The most important distinction to make on a back to school strategy for this
season is that the risks, complexities and comprehensiveness of an effective
back to school strategy makes it imperative that all members of the School
Health community (Students/Pupils, Parents, Teachers, Administrators,
Regulators, International Agencies) must be actively involved in the research
and development, design, implementation, risk management, monitoring and
evaluation of a safe, effective, all-inclusive, back-to-school strategy.
To best serve all students through a time of stress and uncertainty, schools
will need inclusive decision-making processes that leverage the critical
insights of those from the full community. They will need to form a coalition
that includes representation from educators, mental health professionals,
community partners, families, and students to develop a plan for rebuilding
safe, supportive, and equitable environments that provide robust
opportunities for social, emotional, and academic learning in the multiple

7. spaces students grow and develop (e.g., after-school, Head Start, and summer
programs). It is important to ensure that coalitions include members from
historically marginalized groups, including those impacted deeply by events
during school building closures.
A broad coalition of diverse stakeholders will help set a vision for reuniting
and renewing the school community, communicating the importance of SEL
and supporting learning environments, identifying core goals that resonate
across the community, and guiding implementation of a plan that will meet
all students’ needs.
Strategies of engaging the School Health Community includes;
i. Building a virtual school health community using
platforms like email, Instagram, WhatsApp or Facebook.
ii. Conducting periodic conferences where current
local/international evidence are used to educate the school
health community on current practices locally and
internationally.
iii. Having a School Health Committee made up of
representatives of all the stakeholder groups
(Students/Pupils, Parents, Teachers, Administrators,
Regulators, International Agencies) that considers these
evidences and uses them to chart an effective
back-to-school strategy.
iv. Continuously carrying along ALL members of the
school health community through WhatsApp posts,
Facebook posts, podcasts, email newsletters.
v. Actively stimulating feedback from the community,
graciously accepting these feedback, acting on tem,
demonstrating action and reverting to the community what
has been done with the feedback.

8. School mediNet - Building the National School Health Monitoring
Infrastructure.
There now must be massive investments in building NATIONAL (even
INTERNATIONAL) Capacity for managing school health. The
COVID-19 pandemic has demonstrated that “the virus anywhere, threat
to health everywhere”. The National School Health Infrastructure must
include:
I. A​ School Health Committee​ made up of representatives of
all stakeholders in the School Community. This Committee
will serve as a local monitoring organization to evaluate the
implementation of all policies dictated by the school, local,
national or international agencies.
ii. An ​Electronic Medical Record ​of all pupils/students of
these schools with a summary medical record on a School
Health Portal that is accessible to key authorized
stakeholders. This can ensure that a case of COVId-19 in
any School can quickly be detected and appropriate
measures taken to isolate the pupil/school to protect the
larger community.
Iii. State School Health Monitoring Task Force​ that is
composed of public (and private agencies contracted by the
State Healthcare Monitoring Agency) and carries out
periodic inspections of all schools in the state to ensure
compliance with all components of the State Policies and
Guidelines. This taskforce will report findings to the State
Ministry of Health which will take all disciplinary actions
(up to and including the close down of a school when
necessary) to whip erring schools into line.

9. IV. A ​National School Health Technical Committee ​that
continually studies the National “State of Affairs” and
evaluates this vis-à-vis current evidence locally and
internationally, and implements intervention measures as it
deems fit based on evidence.
V. ​A National Database of ALL Schools ​and Learning
Centres with a summary of the Key Performance Indicators
for each School maintained and updated daily. This should
be displayed by a National Dashboard Visible to all
Stakeholders (Nationally and Internationally).
The Safe School Service.
a. Learning from home.
Federal, state and local governments should take responsibility for ensuring
learners are “safe to learn at home.” It is important that all learners participate
in an inclusive arrangement, irrespective of their locations, access to the
internet, and socio-economic background. Further, that they are also safe to
learn regardless of the type of distance learning they engage in. This
involves, for example, sharing public health messages about COVID-19,
including its symptoms, how it is transmitted, and how to prevent
transmission. Furthermore, the impact of COVID-19 means that more
learners are online, which leaves them vulnerable to risky online behavior,
cyber-bullying, sexual exploitation, and other cyber threats. It is
recommended that, for children, continuous child-friendly messaging using
infographics, cartoons, animations, and so on that show how to protect
themselves should also be available in their learning packages.

10. b. Social Distancing.
In schools and other learning facilities, learners should be supported to stay
two meters apart. However, there are exceptions where the two-meter rule
cannot be reasonably applied and other risk mitigation strategies may be
adopted. Examples include early years, younger primary school children, and
those with additional needs. In these circumstances, risk assessments must be
undertaken with the best interests of the learners, teachers, and other
education personnel in mind. The scenarios require organizing learners and
children into small groups with consistent membership and compliance to the
risk mitigation strategies. The membership of these groups should not change
unless the NCDC public health guideline suggests otherwise. The safety and
hygiene measures outlined in this document should, as in all cases, be
followed carefully. It is imperative that safe distancing between adult staff
working with such groups be maintained.
Alternative Models of Learning Should be incorporated Such As:
I. Outdoor Learning.
II. Staggered Attendance.
III. Alternate Attendance.
IV. Platooning.
V. Decreased Interaction.
VI. Flexible Schedules.
VII. Creative Delivery.
C. Mask Mandate
Current Guidelines from the WHO on Children wearing mask is as follows:
Children aged ​5 years and under​ should not be required to wear masks. This
is based on the safety and overall interest of the child and the capacity to
appropriately use a mask with minimal assistance.

11. WHO and UNICEF advise that the decision to use masks for children aged
6-11 ​should be based on the following factors:
● Whether there is widespread transmission in the area where the child
resides.
● The ability of the child to safely and appropriately use a mask.
● Access to masks, as well as laundering and replacement of masks in
certain settings (such as schools and childcare services).
● Adequate adult supervision and instructions to the child on how to put
on, take off and safely wear masks.
● Potential impact of wearing a mask on learning and psychosocial
development, in consultation with teachers, parents/caregivers and/or
medical providers.
● Specific settings and interactions the child has with other people who
are at high risk of developing serious illness, such as the elderly and
those with other underlying health conditions
WHO and UNICEF advise that children aged ​12 and over​ should wear a
mask under the same conditions as adults, in particular when they cannot
guarantee at least a 1-metre distance from others and there is widespread
transmission in the area.
https://www.who.int/news-room/q-a-detail/q-a-children-and-masks-related-to
-covid-19#:~:text=WHO%20and%20UNICEF%20advise%20that%20childre
n%20aged%2012%20and%20over,widespread%20transmission%20in%20th
e%20area​.

12. D. Safety and Hygiene.
1. Disinfect and fumigate facilities, including hostel accommodation;
particular attention given to those used as temporary isolation and
treatment centers and for other purposes during the pandemic .
2. Ensure a School COVID-19 Referral System, including protocols and
procedures to take if learners, teachers, administrators, and other
education personnel become unwell while in schools Develop detailed
protocols and provide facilities and measures for the maintenance of
two-meter safe distancing to comply with NCDC guideline.
3. Develop detailed protocols and provide facilities to establish and
maintain prescribed hygiene standards and practices, including WASH,
hand washing, access to adequate gender-segregated toilet facilities,
cross-ventilation of class rooms and hostel accommodation, use of face
masks, proper food preparation and handling as well as disposal of
wastes.
4. Sensitize, train, and build capacity of teachers, administrators, and
other education personnel to effectively use and comply with the
School COVID-19 Referral System and protocols for safe distancing
and hygiene in schools.
5. Set up school hygiene committees with designated hygiene champions
to monitor and promote compliance.
E. The School-Based Health Centre (SBHC) and Referral System.
The complexities, depth, and breadth of the engagements, service
development and delivery, risk management, research and development,
monitoring and evaluation, and continuity of care that is needed to
conceptualize, deploy and manage effectively and efficiently, a Safe School
System, post COVID-19 is not one that any School can mange on its own.
The need to have a School Based Health Centre with a properly trained and

13. monitored School Nurse is critical to the assurance of the much needed
quality. A School Based Health Centre with a School Nurse will;
1. Educate and Engage the School Community on the School Back to
School Strategy.
2. Ensuring the availability of an Effective School Health Facility with the
appropriate equipment and consumables.
3. Organize a questionnaire-based screening of all members of the School
Community (Students/Teachers/Administrators) before each member is
allowed into the School environment.
4. Continuously monitor the state of health of all members of the
community and carry out necessary interventions up to and including
referrals when necessary.
5. Monitor closely the health of vulnerable members of the community
(e.g. children with chronic diseases like asthma/diabetes/sickle cell
disease, of children with special needs) and ensure appropriate
precautions are taken to prevent them from being exposed to the virus.
This is because current evidence shows that individuals with underlying
medical conditions are very prone to the severe form for the COVID-19
infection.
6. Liase with a Medical Centre with a licensed medical professional for
continuity of care as need be.
7. Liaise with all public health agencies for notification as stipulated.
Summary and Conclusions
As much as it is imperative, due to the multiple risks that children are
facing out of school, to reopen the schools as much as possible, a
hasty, rushed and improperly rushed resumption can only lead to
disaster. A word as they say is enough for the wise.
Finally “On an occasion like this, it becomes more of a moral duty to
speak one’s mind. It becomes a pleasure”.

14. Dr. Segun Ebitanmi read Medicine in the Ahmadu Bello University
Zaria and finished in the late 90s. He started one of Nigeria’s first
Medical Software Companies, Synapses as founder and pioneer
Managing Director. He has supervised implementation of Medical
Software projects from Private Hospitals up to and including
Teaching Hospitals. In running Outreach Hospitals as Chief
Operating Officer he has managed the rapid growth and expansion
of the hospitals to become one of the top ten (10) hospitals, winning
multiple awards in the process. As an astute aficionado of Modern
Information Management Systems Thinking his passion is to deliver
a sustainable, impact driven health system that transforms lives of
100m Nigerians.