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When should #Schools #Reopen in the UK? This thread summarises the key points & evidence on the issue & finishes with some things the government must do before allowing schools to re-open.
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On 20 March 2020, UK schools closed their gates to all but the children of essential workers and those deemed most vulnerable. This remains the case; although the gvmnt has now said that more children will return to school at the start of June.
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School closures have presented a huge challenge to children, parents & policymakers. A study by @TheIFS showed that better-off children now spend 30% more time on education than poorer children & school closures will increase educational inequalities.
https://www.ifs.org.uk/publications/14848
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https://www.ifs.org.uk/publications/14848
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The increasing educational disadvantage means it is urgent to find a SAFE way to resume education. Dismissing concerns from teaching unions as 'scaremongering,' the Education Sec @GavinWilliamson announced that R being below 1 is the ‘green light’ for schools to re-open...
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Whilst @michaelgove said he can 'guarantee teachers and children will be safe.' More reasonably, @WHO chief scientist @doctorsoumya has said children are "less capable of spreading the virus, and are low risk."
https://www.bbc.co.uk/news/education-52697488
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https://www.bbc.co.uk/news/education-52697488
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However, teaching unions & parents have raised legitimate concerns over whether it will really be safe, and @TheBMA announced that "Until we have got case numbers much lower we should not consider re-opening schools. The NEU is right to urge caution."
https://www.theguardian.com/world/2020/may/15/bma-backs-teaching-unions-in-opposing-reopening-of-schools
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https://www.theguardian.com/world/2020/may/15/bma-backs-teaching-unions-in-opposing-reopening-of-schools
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But what is the evidence, and when will UK schools really be able to open safely? This @guardianscience article summarises the contrasting views between experts, with some experts saying it's low risk & a difficult but necessary decision. https://www.theguardian.com/world/2020/may/17/scientists-divided-over-coronavirus-risk-to-children-if-schools-reopen
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It should first be made clear that there is no scientific consensus on this, w/ many contrasting views & little strong evidence on the issue. This uncertainty means there is inherently significant risk involved & increases the need for evidence to be discussed #transparently.
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So let's dig a little into the evidence for & against re-opening schools. A @ucl review published in @LancetChildAdol concluded that the evidence to support the closure of schools to combat Covid-19 is “very weak” & school closures are likely to have a minimal impact...
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...on the spread of the virus. Should be noted that this models school closures and effect on peak rather than the re-opening of schools. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30095-X/fulltext
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And this @ScienceMagazine paper shows risk of infection upon exposure in children may be about 1/3 (sorry for the simplification) that of adults, although also suggests proactive school closures can reduce peak incidence by 40-60% & delay the epidemic.
https://science.sciencemag.org/content/early/2020/05/04/science.abb8001
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https://science.sciencemag.org/content/early/2020/05/04/science.abb8001
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There are also many studies showing lower incidence in children, such as a population-based study in Iceland in which 9199 were tested, of the 564 children <10y, 38 (6.7%) tested positive, vs 1183/8635 (13.7%) adolescents & adults, suggesting lower incidence in children.
There is also a fair bit of contact tracing data suggesting that children are less infectious, such as this in a French chalet cluster, where an infected child did not transmit the disease despite close interactions within schools.
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa424/5819060
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https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa424/5819060
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However, in regards to contact tracing studies suggesting children are less infectious, there needs to be more rigorous data to draw conclusions from this data alone, as need to take into account the potential for #superspreaders.
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Still, Prof @GrahamMedley, UK chief modeller, says children not the 'key drivers' of #coronavirus transmission... And @WHO says in countries where schools have remained open, outbreaks in schools have been rare & are normally associated with contacts with adults.
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And in Denmark, re-opening of schools (w/ effective social distancing measures), led to an increase in R from 0.7 to 0.9 shortly after (although now returned to 0.7). This seems to be the main 'case study' the UK is basing it being safe for schools to re-open.
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These @nytimes & @guardian articles summarise Denmarks approach. https://www.nytimes.com/2020/04/17/world/europe/denmark-schools-coronavirus.html
https://www.theguardian.com/education/2020/may/17/denmark-can-teach-england-safe-reopening-of-schools-covid-19
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https://www.theguardian.com/education/2020/may/17/denmark-can-teach-england-safe-reopening-of-schools-covid-19
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It seems clear that, unlike with influenza, children aren't key drivers of transmission & most will suffer no symptoms. But not being 'the key driver' doesn't mean they can't still drive transmission, & there is increasing concern over a related inflammatory syndrome...
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The man leading the coronavirus response in Germany, @c_drosten, heeds caution, showing evidence there is no sig difference in viral loads between children & adults. This highlights how much we have to learn & that all steps should be taken w/ caution.
https://zoonosen.charite.de/fileadmin/user_upload/microsites/m_cc05/virologie-ccm/dateien_upload/Weitere_Dateien/analysis-of-SARS-CoV-2-viral-load-by-patient-age.pdf
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https://zoonosen.charite.de/fileadmin/user_upload/microsites/m_cc05/virologie-ccm/dateien_upload/Weitere_Dateien/analysis-of-SARS-CoV-2-viral-load-by-patient-age.pdf
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Additionally, work by @ONS, who have been doing some excellent research on the impact of #COVID19 in the UK, showed there is currently no evidence that age affects the likelihood of being infected with #COVID19 in the UK. http://ow.ly/4zPg30qFZuf
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And a retrospective cohort study based on 1286 close contacts of 319 #COVID19 cases in Shenzen showed that children (and younger people generally) were as likely as adults to be infected (but also much less likely to have mild or severe symptoms). https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30287-5/fulltext
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There is also increasing concern with now hundreds of seemingly #COVID19 associated Pims-TS syndrome cases confirmed in several countries. Pims-TS (whole system inflammatory toxic shock syndrome similar to #Kawasaki symptoms) has resulted in...
https://www.theguardian.com/science/2020/may/17/possible-breakthrough-in-coronavirus-related-syndrome-in-children
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https://www.theguardian.com/science/2020/may/17/possible-breakthrough-in-coronavirus-related-syndrome-in-children
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... normally healthy children being in ICU/dying and can have long-term cardiac complications. The disease shows ~4 weeks after initial infection & so likely to see cases increase. We are finding more out about this every day, but more studies (time) are needed.
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And this is what it basically comes down to. There is no consensus view amongst experts. There is little strong evidence for either side, and much of it is contrasting. Can the UK afford to risk it?
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With such little consensus, this now turns into risk assessment and ultimately a political decision, in which the individual risk to children & teachers (& parents) is weighed up against the value of children being in school (and ofc many other things but these are main 2).
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@NYGovCuomo: "We are still learning so much about #COVID19 & the more we learn the worse it seems to get. Whilst the disease is so prevalent in the pop (NY/UK) we shouldn't be risking our children when we know so little."
https://twitter.com/i/status/1261743154027511808
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https://twitter.com/i/status/1261743154027511808
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What should the UK do?
The UK gov seems to be using Denmark as evidence that opening schools is safe. However the situation there is very different from the UK. They have <100 cases a day & recently reported 0 COVID deaths in a day, whilst UK has ~3500 confirmed cases...
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The UK gov seems to be using Denmark as evidence that opening schools is safe. However the situation there is very different from the UK. They have <100 cases a day & recently reported 0 COVID deaths in a day, whilst UK has ~3500 confirmed cases...
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... (likely closer to 20,000 true cases) a day & hundreds of deaths a day. The massive difference in the prevalence of #COVID19 between the UK & Denmark means the risk of infection to children (and their contacts) in Denmark is much lower when compared to the risk in the UK.
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We can't draw conclusions by comparing UK w/ Denmark as the situations are so different (100-1000 fold difference in #COVID19 pop prevalence). @TheBMA and teaching unions are right to say "Until we have got case numbers much lower we shouldn't consider re-opening schools."
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This comes onto a broader point. It is 18 weeks since @WHO declared a #PublicHealthEmergency & 7 weeks into #lockdown. And yet there is still no community #ContactTracing. This paper shows how even moderate contact tracing brings case numbers down.
https://twitter.com/ScienceShared/status/1262320191872131073?s=20
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https://twitter.com/ScienceShared/status/1262320191872131073?s=20
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UK could have reduced R much further by implementing contact tracing during lockdown & brought the total number of cases right down, making it much safer for schools to go back. But we haven't, and still have by far the highest number of cases and deaths per day in Europe...
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...whilst not having schools, non-essential shops etc open. Spain/Italy/NYC have much more comparable outbreaks to the UK than Denmark/Germany, & have announced they aren't opening schools again until September. Are we really about to make the same mistakes all over again?
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Liverpool/Newcastle/Manchester councils are right to say they won't open schools until there is much clearer and #transparent discussion of the evidence to show it is low-risk, specifics of how schools will be re-opened safely, & that R<1 and will stay <1 in every community.
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This comes onto broader issue on the #transparency of the government's scientific advice. Until we know the evidence the gvmnt is using for schools being safe to re-open, how can teachers & parents be expected to accept the decision blindly, esp given how it went first time.?
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The gvmnt has to re-build trust if it wants cooperation. Denmark had same TU issue when they re-opened, but instead of saying they're 'scaremongering' they shared with unions their plans & evidence of it being low risk & overall benefit, & the unions then accepted this.
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Until effective contact tracing reduces case numbers below AT LEAST 1000 a day (I would really push for much lower though), I would deem it unsafe to re-open schools, even with social distancing, especially given the emerging #COVID association with #Kawasaki like disease.
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And if the government does want to re-open schools on 1 June with thousands of cases a day, they should show their evidence for the following:
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1) What the incidence of infection is for children.
2) What the transmission rate in educational settings is.
3) What % of infected children experience no or mild symptoms.
4) What % of children experience moderate or severe symptoms of COVID (and associated Pims-TS).
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2) What the transmission rate in educational settings is.
3) What % of infected children experience no or mild symptoms.
4) What % of children experience moderate or severe symptoms of COVID (and associated Pims-TS).
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5) What % of children require ICU/die.
6) All the above for #COVID associated Pims-TS and % of those children who are likely to suffer long-term cardiac complications as a result of Pims-TS (and what % will get these complications from undetected Pims-TS).
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6) All the above for #COVID associated Pims-TS and % of those children who are likely to suffer long-term cardiac complications as a result of Pims-TS (and what % will get these complications from undetected Pims-TS).
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7) The risk to teachers & staff should also be assessed, particularly those with underlying health conditions.
8) What specific infection control measures & clinical guidance/protocols schools will be following, & what evidence they have that they can reduce the above rates..
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8) What specific infection control measures & clinical guidance/protocols schools will be following, & what evidence they have that they can reduce the above rates..
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..with: details of assumptions, models, evidence, and the confidence interval of these results.
9) How they expect children who have no other means but public transport to get to school, and what they are going to do to ensure safety on way/home/during break times.
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9) How they expect children who have no other means but public transport to get to school, and what they are going to do to ensure safety on way/home/during break times.
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10) What their guidance is to schools for when some parents inevitably do not send their children back to school as they deem it unsafe to do so.
Credit to @adamhamdy for forming the base of these evidence criteria for reopening schools.
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Credit to @adamhamdy for forming the base of these evidence criteria for reopening schools.
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Until the gvmt show the public, & importantly the many concerned teachers & parents, the evidence behind their decisions, schools should not reopen, esp if case numbers stay in the 1000s per day, or test/trace/isolate is still not implemented (which has had numerous delays).
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It's morally reprehensible & entirely unhelpful for gvmt ministers to push teachers to say TUs raising concerns for their own safety are 'scaremongering' esp when there's so little clarity in published evidence & much uncertainty/mistrust due to handling so far.
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The gvmnt response to schools re-opening has been to downplay the risk. But both these statements cannot be true:
A) Children do not transmit the virus effectively (suggesting a low rate of infection among children)
B) Pims-TS is a rare complication
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A) Children do not transmit the virus effectively (suggesting a low rate of infection among children)
B) Pims-TS is a rare complication
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Either children are efficient transmitters of #SARSCov2 and Pims-TS is rare, or children are not efficient transmitters & Pims-TS is a worryingly frequent complication. It is not the job of unions or teachers to prove or disprove risk. It is up to the government.
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Proving schools are safe to re-open is not the same as reassurance or exhortation by the government. This thread is not saying outright that we shouldn't re-open yet, but the evidence for it being safe/low-risk to re-open must be published, and justified concerns addressed.
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It would be amazing if @IndependentSage could review the issue of re-opening schools & publicly release a consensus statement & recommendations for the gvmt on this issue. @globalhlthtwit @carolecadwalla @Sir_David_King @TeebzR @GrahamMedley @jneill ^thread is worth a read.
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