20 scientists and public health professionals, hundreds of parents and students, and national education unions are asking that the UK Government follows the data not dates by extending face mask mitigation in schools.


First published in May 2021.


The COVID Action Group, a network of pandemic experts, scientists, researchers, and communicators with a mission to advise the country about how to eliminate the COVID-19 virus has written an open letter to the Secretary of State for Education, Gavin Williamson, regarding the need to continue wearing face coverings as a mitigatory measure against SARS-CoV-2 in schools.

The open letter to Gavin Williamson, which has already been signed by thousands of experts, parents, students, and teaching unions, asks the government not to remove the requirement for pupils to wear face coverings in secondary school classrooms after 17 May.

There aren’t currently any plans from the government to lift the requirement to wear masks in shops or on transport. Why schools, then, where students are in close contact for most of the day?


To: Mr. Gavin Williamson

“We are extremely concerned at reports that the government plans to stop requiring children to wear face coverings in secondary school classrooms from 17th May in England. We are not aware of any plans to lift face covering requirements in relation to shops or transport, where people generally spend less time in close contact with large groups.

We support the general principle of using data not dates to decide on the lifting of restrictions. However, while there is significant community transmission (Independent SAGE’s suggested threshold is 10 cases/100,000 population/week with strong test, trace isolate and support systems, while Victoria, Australia was successful by targeting <1 case/100,000 population/week), we view face coverings (along with other measures such as improved ventilation, air purification, using outdoor spaces, and mass testing) as an essential part of the wider system of control in schools. Masks reduce the risk of children contracting and transmitting SARS-CoV-2, as wearing a face covering in class reduces the emission of virus-carrying particles as well as reducing wearers’ exposure due to filtration.1

Both the CDC and WHO recommend that children wear masks in schools, including in classrooms.2,3 Not only do masks help keep school students and staff safe, they are also a critical part of the overall effort to reduce community transmission and allow the safe lifting of restrictions in general to be achieved as soon as possible. They also minimise educational disruption, allowing children to remain in school, while also protecting household members, including clinically vulnerable contacts, from onward risk of infection.

This is important both for protecting the health of our children and the staff who look after them, as well as our wider communities. Data from the Office for National Statistics (ONS) infection survey has shown that the number of positive COVID cases among school age children closely tracks school openings, closures and attendance.4 After schools opened in England (8th March), the number of children testing positive for COVID-19 increased and by the start of the Easter break, prevalence of infection was higher in school age children than in any other age group.5 As more children have been infected, we have seen increased positivity among young adults, and plateauing of declines in infection while schools were open.5 Notably, we see reversal of this pattern over Easter break, with declines in prevalence of infection resuming across the UK following school holiday closure,5 further supporting the role of schools in community transmission of SARS-CoV-2.

It is extremely worrying that we saw such marked case rises over March among children, given that schools were only open for a few weeks, and with mitigations such as mask wearing in place for secondary school children (although only recommended when distancing could not be maintained). We note that although there were increases in both primary and secondary school age groups, rises were sharper among primary school age groups, potentially due to mitigations, including masks, in secondary schools reducing the rate of spread. This would suggest that more robust mitigations are needed, rather than removal of one of the few mitigations currently in place. Indeed, evidence from a study of around half a million parents in the US shows that parents of children in school are at higher risk of infection, but that this risk can be mitigated with multi-layered measures, including mask use within classrooms.6 Concerningly, we have seen outbreaks of B.1.351, B.1.617 and B.1.1.7 +E484K sub-lineage linked to schools,7,8,9 suggesting that school outbreaks are contributing to community spread of these concerning variants.

We also know from ONS data that 10% of primary school age children and 13% of secondary school age children have persistent symptoms even 5 weeks after the initial infection.10 Between 7-8% have symptoms that persist for at least 12 weeks. We have an estimated 43,000 children, and 114,000 teaching and educational staff living with long COVID, a syndrome whose impact on children and adults long-term is poorly understood.10 The ONS data indicates that two-thirds of people with long COVID have some degree of limitation in activity,10 suggesting that the condition has important impacts on people’s day to day lives.

Mask wearing is practised widely in both primary and secondary school classrooms in most countries in Europe, US and South East Asia, and recommended as an important mitigatory measure to protect children, staff, families and the broader community. In this context, it is surprising that the UK government which has claimed to be ‘following the science’ and ‘following data not dates’, would consider setting an arbitrary date for removing the widely recommended measure of face coverings from its already inadequate set of mitigations in schools, without any reference to ‘the data’.

On the 6th of April 2021, the DfE published a statement following their review of evidence, in which they said ‘Alongside rapid testing, the available scientific evidence is that, when used correctly, wearing a face covering reduces the emission of virus-carrying particles when worn by an infected user, helping to protect others.’ A little over a week since schools have reopened after the Easter break, it does not seem possible that new evidence of such weight could have emerged to cause the DfE to reverse its conclusions from the 6th of April. Indeed, surveys conducted by Unison on 7,636 staff prior to this review showed support for mask use among teaching and support staff, and high adherence among children.11 Many schools are expecting their clinically extremely vulnerable staff to return to the workplace despite the continuing message to work from home if possible, and recognition that vaccination is not 100 per cent effective. Against this background any relaxation of mask use would cause great anxiety among the staff and students at greater risk.

While a significant proportion of the UK population has at least received a single dose of vaccine, this is not sufficient to fully mitigate the impact of transmission among children on infection rates in the community. Countries like Israel fully emerged from lockdown after fully vaccinating >80% of adults, and only re-opened schools fully in the last few weeks, with mitigations still in place, including mask mandates in classrooms.

Millions of children across the globe wear masks in classrooms every day. There are substantial benefits to wearing masks in schools while significant community transmission continues. Given legitimate concerns about impact on children and families from school closures, we highlight that wearing masks can reduce transmission in schools, which will help ensure that children remain in classrooms and continue in-person education without disruption. Evidence both in the UK and worldwide does not suggest harm of general use to either adults or children, and whilst we acknowledge that it may be more challenging to communicate while wearing masks, and accept that some children and adults may not be able to wear them, it is very clear that the benefits far outweigh any potential risks at the current time. We support mask wearing in schools at this time, with exemptions for children who cannot wear them. Clear face coverings may aid communication. We call on the government to provide clear masks for staff and school children, where needed, in order to aid communication and we support exemptions for children who cannot wear masks.

We urge the government to consider the global and national evidence on current infection rates in schools when making decisions about face coverings in school. These should be continued in schools after the 17th May, with review prior to the next stage of the roadmap on the 21st June. To strip these necessary covid protections, when there are already too few mitigation measures in schools, and when rates of Covid-19 are still significant would have consequences for the health of our children and their parents as well as their communities.” 


If you would like to support this letter, co-sign here!




References

  1. Science Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2, Nov. 20, 2020
  2. Centers for Disease Control. Schools and Child Care Programs​: Plan, Prepare, and Respond. Apr. 5, 2021. (accessed 26th April 2021).
  3. World Health Organisation. Coronavirus disease (COVID-19): Schools. 2020.
  4. Gurdasani D, Alwan NA, Greenhalgh T, et al. School reopening without robust COVID-19 mitigation risks accelerating the pandemic. Lancet 2021; 397(10280): 1177-8.
  5. Office for National Statistics. Coronavirus (COVID-19) Infection Survey, UK: 23 April 2021. 2021.
  6. Lessler J GM, Grantz KH, Badillo-Goicoechea E, Metcalf JE, Lupton-Smith C, Azman AS, Stuart EA. Household COVID-19 risk and in-person schooling. MedRxiv 2021.
  7. Covid: Mutation of UK variant found in Telford and Wrekin schools. BBC News. 2021.
  8. Reed J. Covid: South Africa variant surge probably due to person travelling from Africa. BBC News.Sect.
  9. First cases of Indian variant Covid-19 found in Leicester. Leicester News. 28 April 2021.
  10. Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021.
  11. UNISON. Face coverings in schools make staff feel safer​. 2021.


PMP News reporting.



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[This piece was first published in PMP Magazine on 4 May 2021. | The author writes in a personal capacity.]

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