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There have been several media reports suggesting that ministers may announce an end to the self-isolation policy for pupils when they return to school in September.
Prof James Hargreaves, Professor of Epidemiology and Evaluation, London School of Hygiene & Tropical Medicine, said:
“School communities have worked hard in the most difficult of circumstances this year to keep staff and students safe. Three main approaches have been used. First, have been efforts to ensure infected persons, including those without symptoms, do not come to school. Early in the pandemic these measures focused on advice to parents, students and staff, aligned with broader isolation advice for symptomatic individuals. Some schools implemented temperature or symptom screening at the school gate. Partial school closures have been a key element of lockdowns. The “bubble” system in which contacts of cases of proven infection were required to stay at home for 10 days was implemented. Most recently, the mass asymptomatic screening programme for staff and students has been implemented.
“Second, have been efforts to prevent transmission within schools, allowing for the risk that the above “school gate” measures would likely not be 100% effective. These measures have included extensive cleaning and hygiene protocols within school buildings, as well as social distancing measures where these have been feasible, and, for example, restriction of curricular and extracurricular activities such as sport and singing.
“Third, schools and teachers have had to adapt very quickly in providing education by remote or blended learning models.
“The pressure on school communities throughout the year has been significant.
“While it has not been easy to measure the impacts of these measures individually, evidence suggests they have had some positive impacts in controlling COVID transmission. Studies around the world have found limited evidence of widespread in-school transmission, and where this has been identified, poor infection control practice has been cited as an important factor. Infections within school communities appear lower than the community at large, suggesting an impact of “school gate” measures. Infection and antibody levels in school staff have not been found to be higher than among other working age adult populations. However, growing evidence suggests that the measures have had an unequal impact on the health, education and well-being of children, and that teachers and school staff have been under great pressure responding to the pandemic.
“The vaccination programme has now reached many school staff, and continues to expand. If proven safe and acceptable, vaccination of whole school populations would be the most effective measure to reduce transmission in schools, relieve the burden on schools, and get students back to school. However, given the success of the efforts schools have made to date, the risks to society as a whole of currently growing levels of COVID transmission, the damaging effects of school exclusion on children’s education and health, and uncertainty and a need for more data related to offering vaccination to children, decisions about relaxing school implementation of COVID-19 control efforts will need to be taken carefully. Schools will continue to urgently require expanded support to cope with the pandemic and its impacts.”
Comments sent out 29/06/2021:
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“The cost of keeping children away from school is obviously incredibly damaging. However, we similarly cannot ignore the damage done to children and young adults as a result of COVID, which continues to be under-represented and will no-doubt increase if the spread of the Delta variant goes unchecked. Childhood cases account for around 8% of hospitalisations (PHE dashboard, https://t.co/3omOB7QEYz?amp=1). In addition, the incidence of long COVID symptoms in children appears somewhere around one in ten (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/962830/s1079-ons-update-on-long-covid-prevalence-estimate.pdf; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927578/), and we do not fully understand the longer term consequences of even mild SARS-CoV2 infection.
“Spread of the now dominant Delta variant is clearly occurring mainly in younger age groups, so surely the best possible way to protect children’s education and wellbeing is, much like the economy, to control the spread of the virus? The removal of mandatory mask wearing was clearly a mistake and demonstrates the folly of imposing political choices upon public health scenarios. Moreover, the size of bubbles required to be collapsed could have been reduced by providing additional staff or accommodation in order to reduce class sizes. I would also suggest that advisory testing is likely to have seen relatively poor compliance compared with when schools first returned in March – this defeats the objective of asymptomatic testing. Little has been done to improve classroom ventilation and the awareness of aerosol transmission. Whilst school transmission generally mirrors that in the community, both can act in concert to amplify local prevalence.
“Trials have supported that mRNA vaccines are safe to use in children aged 12 and over and they are approved for such use in several countries. Whilst I fully support the drive to address global vaccine inequality, the doses required to complete an effective population immunisation programme here in the UK represents a drop in the ocean; there are far greater issues at play. We must also consider the longevity of vaccination programmes, best managed through schools, as well as the fact that a great many individuals are either unable to receive, or respond to vaccines in our communities. This group will only be effectively protected from COVID if we reach sufficient coverage across the UK population as a whole such that outbreaks are quickly restricted by the scarcity of susceptible individuals. I would therefore urge the government to apply precautionary principle in its approach to schools and COVID transmission, it certainly should not be ignored.”
Prof Paul Hunter, Professor in Medicine, UEA, said:
“In my view the disadvantages of continuing to exclude large numbers of children in the autumn if one in the year has been in contact with a case of COVID would greatly outweigh any benefits. The benefits of such exclusions apply if it is reasonable that we could eliminate COVID from society. I think virtually every expert now accepts that this will never happen in large part because though vaccines are very good at preventing severe disease and death they are not so good at preventing infection.
“If we look at the other four human coronaviruses, the last one probably jumped into humans from cattle around 1890, these viruses cause repeat infections throughout our lives though rarely cause severe disease and usually present as one of the causes of the common cold. Given what we know about the other Coronaviruses, whether or not we have been vaccinated against COVID most of us can expect to experience repeat COVID infections throughout our lives from now onwards.
“If we accept that eventually infection is inevitable then, providing spread within the school environment does not cause intolerable pressure on the health service, delaying an inevitable infection in children through repeated testing exclusion will have very little benefit for the children themselves and substantial harm to their education.
“To my mind the value of repeat testing of children with subsequent school exclusions have run their course and should not be continued in the autumn.”
Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester, said:
“We accept that returning to a normal school environment is best for children.
“With more vulnerable adults now vaccinated the risk of poor clinical outcomes of COVID-19 infection and disease resulting from transmission from infected children is now much less.
“Each year, outbreaks of respiratory viruses in schools amongst children are quite typical – with influenza, RSV, parainfluenza, rhinoviruses, other seasonal (non-SARS) coronaviruses, adenoviruses, etc. – with only individual sick children staying home – of which a few may become more severely ill and need hospitalisation.
“But we don’t impose any further restrictions for these viruses – though we do have an optional primary school influenza vaccination programme for schoolchildren.
“We could do the same for COVID-19/SARS-COV-2, of course – as we ‘learn to live with’ this virus.
“The only issue is that we don’t see long COVID-equivalent complications for these other seasonal respiratory viruses in children.
“So if we return to ‘normal’ for schools and just treat seasonal ‘COVID-19’ as we do for these other respiratory viruses – we should be prepared for these potential ‘long-COVID’ risks and complications.”
Prof Russell Viner, Professor of Child and Adolescent Health, UCL, said:
“The isolation of ‘bubbles’ system in schools is a modified test, trace and isolate (TTI) system developed for schools early in the pandemic, and modified more recently by the use of regular lateral flow device (LFD) testing.
“It is important for us to note that the reopening of UK schools in early March 2021 was highly successful. This was achieved during a time of high prevalence, in the midst of great uncertainty about the impacts of a new and highly transmissible variant (Kent -now alpha) – and community infection levels fell steadily for many weeks after the reopening. This supports the view that schools are not the major drivers of this pandemic, although we know that children within households transmit this virus as much as adults. The literature and the UK reopening both suggest that NPI controls in school have meant that schools have played only a supporting role in transmission of this virus. This means that we must have care when dismantling a system that has been shown to work.
“Yet this system appears now to be having very significant unintended consequences in terms of loss of education and social isolation, with impacts upon children’s mental health.
“It is now time to undertake an evidence-based reassessment of our system of controls in schools for September. We will then have a nearly fully vaccinated adult population – which undoubtedly changes the balance of risks for the controls which we place on our children and young people in schools. Children and young people will be the only substantial unvaccinated segment of the population – and we must be careful that we don’t apply unnecessary controls to their lives in schools when vaccinated adults have more freedom.
“This reassessment must balance evidence of benefits of bubbles and other controls for risk to broader society, with the evidence of harms we are now seeing. We must examine:
“Through this we should remember that the controls that have been put in place in schools during COVID are very much designed to protect broader society (i.e. adults), as children and young people remain at extremely low risk from infection. This is similar to the vaccination debate for teenagers: we need to be exceptionally careful that interventions designed to reduce transmission (which benefit vulnerable adults in particular) cause minimal harm to children and young people whilst also bringing them some benefit.”
Prof John Edmunds, Professor in the Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, said:
“The prevalence of infection in school children attending school has been lower than the prevalence of infection in the same age groups in the community, suggesting that isolation of “bubbles” has worked at reducing infection in schools. It is, of course, very disruptive, particularly as prevalence increases, as is occurring at the moment. Vaccination of school children would be a far better method for reducing transmission in school without disruption, but we need to be sure that the vaccines are safe enough to use in children before considering this option.”
https://www.bbc.co.uk/news/health-57638369
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