As confusion surrounds the demands on ECE centres, it’s important to remember the risks inherent in these environments, writes Mike Bedford, a specialist in health and wellbeing in early childhood education.
This week has seen disagreements over whether it is safe for politicians to resume in the parliamentary debating chamber in level three. At the same time early childhood teachers are being told to return to work by the Ministry of Education in potentially crowded environments, with no serious hope of physical distancing and inadequate protection, exposed to up to a dozen “bubbles”.
In my view no other New Zealanders are being put at risk in this way. I can see no public health logic in the position of either the Ministry of Education or Ministry of Health on this.
Consider this. It’s normal and unavoidable for ECE teachers to be directly coughed and sneezed on. The Ministry of Education has expanded the minimum space per child from 2.5 square metres to three square metres, yet this amount of space would be ruled illegal overcrowding in Australia and many other jurisdictions. With our very poor teacher-to-child ratios, you could have just two teachers with 10 children under two years old – a ratio teachers have described to me as unmanageable under normal circumstances, in a very crowded, poorly ventilated space. Research has shown exceptionally poor ventilation in some ECE infant rooms and sleep rooms. ECE centres are some of the highest risk environments for viral transmission we know of.
Pressure on centres to open
The communication around this has been confusing for me and for owners and teachers. In the Ministry of Education Bulletins, the official word was they expected centres to open in alert level three unless they had no children attending, a case connected to their centre, or could claim emergency (code EC) funding. How do they qualify for EC funding? In the Bulletin on Monday of this week they said that you could get this funding if “the service can’t operate safely within public health parameters”. The ministry said, “If your service chooses to stay closed for any other reason [than those above], then you will not be funded.”
Remember, the prime minister said on Tuesday that “risk in the community remains high”. Level three is defined as “There are multiple cases of community transmission, and/or there are multiple active clusters in multiple regions.”
I asked the secretary of education, Iona Holstead to clarify this, to reassure centres they were not being coerced into opening – bearing in mind that if there was community transmission they couldn’t operate safely. The following day, August 31, the ministry changed the wording to, “If you are not able to meet public health measures”, dropping the word “safely”. This looked even worse. The reply I received from the secretary simply referred me back to the information in the Bulletin and MoE website. However, yesterday, on September 2, they reverted to the original Bulletin wording. Confused?
When The Spinoff asked the Ministry of Education if it could confirm the position “that centres can operate safely in level three within public health parameters”, the ministry did not answer directly, but noted they had been advised by the Ministry of Health as follows: “On the advice of the Director General of Health, ‘Early childcare’ services that can meet the public health requirements and operate safely at alert level three can open for parents or carers who need to go to work and have no available options for childcare.”
Two very important points here. This advice has the qualifier of being able to operate safely, with no suggestion for the Ministry of Education could coerce opening in a level three scenario. In addition, it says they can open, not, they must open.
The thing is, some centres simply can’t afford to stay closed without funding, and it’s been made clear to me that teachers are being directed by their employers to come to work, whether they feel safe doing so or not. There’s more to the funding picture here then we can cover in this article, but many ECE centers, especially the best quality ones, are really hurting. They can’t financially carry the loss of staying closed without funding while still paying teachers. Meanwhile Facebook group discussions suggest it’s been made clear to regional staff that they have to open. Teachers say there has been no requirement for parents to prove their need for care. with some parents seeking to place their children in centres because it would be easier for them to work from home. Others wanted their child there because their child was bored. And this is level three.
My assessment is unambiguous: ECE centres are categorically unsafe in relation to Covid-19 delta. The evidence is against opening ECE centres in level three if there is any community transmission.
During the national level four lockdown last year many of us urged the Ministry of Education not to push children back into childcare any earlier than absolutely necessary, with mixed success. This year, given the potency of the delta variant, it is even more important. It is clear delta represents not only a higher risk of transmission, but it can also be contracted and passed on by children. At this point we have had six infections in children under a year old. Ashley Bloomfield has just said Covid 19 is “reaching right across age groups”. ECE and care environments are automatically high risk for viral transmission, and we have seen the difficulty that ECE and care centres have had with another viral infection, RSV. There is no indication that delta variant is worse for children if they get it, but the infection risk and transmission has increased, and we have 30,000 early childhood teachers being put at risk.
A sector at breaking point
It’s not only the greater infectivity and risk to children that makes the current situation worse for ECE though. Last year the health and education ministries were warned that the sector was already at breaking point even without Covid-19, because of our poor conditions in many ECE centres. These poor conditions result in part from our substandard regulations, and partly from lack of adequate monitoring by the Ministry of Education. The result has been gross overcrowding and poor teacher-child ratios, in a context where we normally have no controls on group size.
Because of these poor conditions, we now have a serious teacher shortage, which makes management of hygiene even more difficult than it was before. While pay is an issue for early childhood teachers (and I totally support better pay), every one of the many ECE teachers I’ve spoken to who have quit centre-based ECE said it was the conditions that made them leave. They couldn’t do their jobs properly any more, and some said they couldn’t condone what we were doing to children in this system.
Information about Covid-19 safety
Last year, the Ministry of Education claimed that precautions within early childhood centres could render them safe against Covid-19, even issuing reassuring form letters that ECE services could send out to parents telling them that the centres were safe. In my view this is simply false. It was done without checking conditions in the centres themselves, at a time when there were desperate concerns coming from the sector about quality and compliance. I was so concerned that this might happen again, that I issued a warning to both ministries, as qualified expert advice, not to declare any centre safe from Covid-19 transmission by reason of hygiene measures within the centre. They have refrained from doing so this time, but it still seem to me to be downplaying the risk to teachers and children. I have asked the ministry whether centres who refuse to open for safety reasons face a withdrawal of funding. I am yet to receive a response.
It really is a difficult time for all of us, and we really feel for working parents. But in my view only an absence of community transmission can assure us that it is safe for ECE centres to operate. It is just the same as it would be for any high density social environment, with high levels of very close inter-personal contact, and no masks being worn.
A final note: none of this should be misinterpreted as a push for early vaccination for children. Caution around giving a new vaccination to children while trials are completed is absolutely sensible. At this stage, the best thing we can do is to support parents to find alternatives to group care if they can.
Dr Mike Bedford is a specialist in ECE health, with nearly three decades experience including some 1,500 ECE centre visits, a Master of Public Health and PhD focused on ECE health.