This article was written by our Co-chair Dr John Puntis in response to a letter in the BMJ, Children are not Covid19 super spreaders, time to go back to school.
Some have wrongly suggested that evidence pointing to children not being major spreaders of coronavirus means that it is safe for schools everywhere to open up. If only it were that simple. In fact, the question in need of an answer is ‘what effect will re-opening schools to all pupils have on the local community in terms of spread of infection?’. Schools not only vary with regard to feasibility of social distancing (still considered essential), and risk factors for severity of illness among staff and pupils, but simply do not operate in a social vacuum. What happens in schools will have ramifications for everyone within and outside of schools. This is much more of a worry than risk to children themselves. The evidence indicates that risk of death from coronavirus infection in children is very low (and the condition of Kawasaki like ‘Paediatric Inflammatory Syndrome’ highlighted in the media is extremely rare).
When the reproduction rate (R value) for the virus is above 1, increasing spread of the infection is predictable. When, for example, R is above 1 in the North East of England as at present, can it really make sense to open up the schools? In fact we need detailed information about R in local communities to be made available in order to make rational decisions about easing lockdown in general. The Independent SAGE (ISAGE) group report recommended that “decisions on school opening be made at local level, involving all stakeholders, to ensure there is support available as schools progress to full function”. The UK government’s own criteria for easing lockdown included a requirement for measures to be in place to avoid a second wave of infection, and this involved having an effective ‘test and track’ system being up and running. This was effectively reiterated by the Children’s Commissioner, who while calling for a phased return to school also said this should be “accompanied by rigorous Covid-19 testing of teachers, children and families to ease safety fears among parents”. We do not have this as yet.
Government was fixated on schools opening their doors to more pupils on June 1st without considering just how this could be facilitated, and at a time when new cases of infection and deaths occurring daily were estimated to be around 17,000 and 300 respectively. Getting tested even for those with typical symptoms of Covid-19 infection has proved problematic, while contact tracing systems at the start of June were only just being launched and may not be fully working until the end of September (if by then!). Widespread testing, and effective contract tracing followed by isolation of contacts is the only way for us to get on top of Covid-19 without having a vaccine - and a vaccine may never materialise.
The government approach to this crucial contract tracing has been to ignore local expertise, to centralize the process rather than locate it in communities, and to give responsibility for organisation to the private sector. Unfortunately, it is hard to see this approach ever being effective. Early data shows that only one third of those testing positive for coronavirus in England were prepared to provide details of their contacts, and just how many of those contacts then agreed to self isolate is unknown. In it’s fourth report, ISAGE gives a bleak assessment of the current ‘test and track’ organisation, saying it is “severely constrained by the lack of coordination, lack of trust, lack of evidence of utility, and centralisation, such that achieving the goal of isolating 80 per cent of close contacts is impossible”. More generally, lack of trust in government stemming from refusal to acknowledge mistakes and inconsistencies in advice regarding rules for social isolation has led many parents to keep their children out of schools, with only one in four of those eligible returning in early June.
Of course schools need to have hygiene and social distancing measures in place as well as conducting risk assessments for staff and pupils (major undertakings) but decisions on school opening up further must be guided by evidence of low levels of Covid-19 infections in the community and the ability to rapidly respond to new infections through a local test, track and isolate strategy. In other words, school opening to more pupils has to be put in the wider context of easing lockdown and the effect this has on numbers of those ill with the virus. Meanwhile, a plan is needed for education with great work having been done on this by the National Education Union. Transparency and honesty from those in power will also be required to rebuild faith in official advice if parents are to feel reassured that going to school is in fact safe.