The lack of robust mitigation measures in schools puts children at greater risk of Covid-19 infection and its consequences. This open letter calls for robust mitigation measures to make schools safe.
First published in September 2021.
The Rt Hon Gavin Williamson MP
Secretary of state for education
Department for Education
20 Great Smith Street
Dear Mr Williamson,
We write as researchers, parents, and educators concerned about the impact of the pandemic on children’s education. Like you, and in agreement with the World Health Organization (WHO), we recognise the importance of schools staying open over the autumn and in the longer term. However, as the WHO also notes, schools must be made safe by adopting measures to minimise transmission of the SARS-CoV-2 virus. We are therefore writing to express our concerns about the lack of mitigations for children and educational staff, and the subsequent risk to children from covid-19 as schools reopen in England this September. We offer nine evidence-based recommendations to reduce new infections in children.
Children have suffered significant harms from covid-19. In just the past two months there have been over 2 300 hospitalisations of under 18s in England. There are an estimated 34 000 children living with long covid in the UK already, with 22 000 reporting significant impacts on their day to day activities, 7 000 of whom have had symptoms for more than a year (Office for National Statistics). Up to one in seven of those infected are expected to have persisting symptoms at 12-15 weeks. Long covid can be associated with multisystem disease in some children, including persistent cognitive symptoms. SARS-CoV-2 is a neurotrophic and pro-inflammatory virus with neuroinvasive potential that can infect the brain, with structural brain changes having been observed in adults, including those with mild infection. Allowing mass infection of children is therefore reckless.
The evidence from Scotland and the USA, where schools reopened a few weeks ago, suggests that the lack of adequate mitigations will likely lead to infections spreading among children and significant absences due to student and staff illness, further disrupting learning.
Children are now returning to school against a background of community infection levels 26 times higher than at the same time last year, and with the much more transmissible Delta variant accounting for almost all infections. Currently, one in 50 primary school children and one in 40 secondary school children have prevalent infection (ONS) and we are experiencing 40-50 hospitalisations in under 18s every day. The Scientific Advisory Group for Emergencies (SAGE) has warned that schools returning will likely lead to significant increases in cases in school age groups. This will coincide with increased pressure on the NHS over winter due to other respiratory viruses, and potentially alongside waning SARS-CoV-2 immunity among the most vulnerable. This puts everyone at risk, and exacerbates the additional burden on people from disadvantaged areas, as well as those predisposed to more severe disease from Black and Asian communities.
Both the European Centre for Disease Prevention and Control (ECDC) and the US Centers for Disease Control and Prevention (CDC) have recommended vaccination of teenagers, together with a combination of measures such as masking, small bubbles, testing, and improved ventilation in schools this autumn to keep children safer and in education. England has not followed this advice. There has been no plan for robust mitigation measures in schools to reduce the risk to children from infection and the consequences thereof, including long covid, hospitalisations, staff safety, and educational disruption. In England, there is no requirement for masks, bubbles, physical distancing, or contact tracing within schools.
Despite MHRA approval, the UK Joint Committee on Vaccination and Immunisation (JCVI) has not yet recommended vaccination of all 12-15-year-olds, and their recommendation to vaccinate 16-17-year-olds has come too late to complete vaccination of adolescents before they return to schools, despite clear evidence that benefits far outweigh risk at current levels of infection. Meanwhile, over 12 million under 18s have been vaccinated across the world.
England’s policies mean that we will soon have a large susceptible population with a high prevalence of infection mixing in crowded environments with hardly any mitigations.
The government has a duty to protect children, our wider communities, and the NHS and healthcare workers from the impact of a fourth wave following schools re-opening. We suggest a nine-point plan to achieve this:
- Offer vaccines to all 12-15-year-olds, with roll-out in schools to maximise access and uptake.
- Immediately reinstate face coverings for secondary school students and staff in classrooms and communal areas as long as community transmission remains high, with provision by your department of high-grade masks to schools.
- Urgently invest in both building ventilation and supplemental ventilation in schools by provision of air filtration devices as needed, with CO2 monitoring of indoor spaces to ensure that targets are met.
- Reinstate bubbles, this time with appropriate maximum sizes to minimise educational disruption, while properly containing transmission.
- Reinstate contact tracing by schools with a strict policy on mandatory isolation and PCR testing of all contacts of cases (in bubbles or households) to prevent onward spread.
- Improve financial and practical support for self-isolation as this will improve uptake of rapid tests in schools.
- Provide remote learning options and support, including wifi, tablets, and/or laptops for clinically vulnerable children, children living in households with clinically vulnerable members, and those required to self-isolate.
- Remove mandatory attendance policies and prosecutions and fines for parents, so that a parent can make a choice of learning modality that is in the best interests of their child.
- Provide mental health support in schools for students and staff.
The above measures should be implemented alongside multi-layered public health measures to reduce community transmission, which will also reduce the potential for outbreaks in educational settings, allowing children to remain in schools safely.
Deepti Gurdasani, Queen Mary University of London, UK
Yaneer Bar-Yam, New England Complex Systems Institute, USA, Founder World Health Network
Spiros Denaxas, University College London, UK
Trisha Greenhalgh, University of Oxford, UK
Stephen Griffin, University of Leeds, UK
Zubaida Haque, Independent SAGE, UK
Zoë Hyde, University of Western Australia, Australia
Aris Katzourakis, University of Oxford, UK
Martin McKee, London School of Hygiene & Tropical Medicine, UK
Susan Michie, University College London, UK
Christina Pagel, University College London, UK
Stephen Reicher, University of St. Andrews, UK
Alice Roberts, University of Birmingham, UK
Christopher Tomlinson, University College London, UK
Kit Yates, University of Bath, UK
Hisham Ziauddeen, University of Cambridge, UK
Competing interests: Zubaida Haque, Martin McKee, Susan Michie, Christina Pagel, Stephen Reicher, and Kit Yates are members of Independent SAGE. Nothing further declared.
On behalf of the full list of co-signatories listed below.
Scientists and healthcare professionals:
Dr. Deepti Gurdasani, Queen Mary University of London, UK
Dr. Hisham Ziauddeen, University of Cambridge, UK
Prof. Susan Michie, University College London, UK
Prof. Christina Pagel, University College London, UK
Dr. Zubaida Haque, Independent SAGE, UK
Prof. Trisha Greenhalgh, University of Oxford, UK
Dr. Stephen Griffin, University of Leeds, UK
Prof. Martin McKee, London School of Hygiene & Tropical Medicine, UK
Dr Eric Feigl-Ding, Federation of American Scientists, US
Dr. Zoë Hyde, University of Western Australia, Australia
Prof. Aris Katzourakis, University of Oxford, UK
Dr Kit Yates, University of Bath, UK
Prof. Stephen Reicher, University of St. Andrews, UK
Dr Joe Pajak, FRSC, CSci, NHS Foundation Trust Governor, UK
Prof. Yaneer Bar-Yam, New England Complex Systems Institute, USA, Founder World Health Network.
Dr. Christopher Tomlinson, University College London, UK
Prof. Alice Roberts, University of Birmingham, UK
Dr Eilir Hughes GP, Fresh Air Wales
Dr. Alison George, GP, UK
Prof. KK Cheng, University of Birmingham, UK
Prof. Carlos Gershenson, Universidad Nacional Autónoma de México
Greta Fox, FNP-BC, COVID Action Group, World Health Network
Prof. Spiros Denaxas, University College London, UK
Prof. Matthias F Schneider, Technical University of Dortmund, Germany
Dr S A Aftab, Chair BMA Yorkshire Consultant Committee, NHS Foundation Trust Governor, UK
Prof. Sunil Raina, Head, Community Medicine, Dr. RP Govt. Medical College, India, World Health Network
Cécile Philippe, economist, Institut économique Molinari, World Health Network, France
Dr. Gunhild Alvik Nyborg, researcher, Covid Action Group, Norway
Joshua P Cohen, health economist, independent healthcare analyst, Boston, Massachusetts
Margo Watroba, strategist, Business Economist, New England Complex Systems Institute, World Health Network, USA
Elisa Zeno, research engineer, France
Dr. Michaël Rochoy, University of Lille, France
Prof Andrew Ewing, University of Gothenburg, Sweden
Dr. Asit Kumar Mishra, NUI Galway, Ireland
Dr. Jonathan Howard, associate professor of neurology and psychiatry at NYU and chief of Neurology service at Bellevue hospital
One Voice Support Group for CV & CEV Families UK
Parents United UK
Contamination Concerns During Covid-19 UK
World Health Network
Covid Action Group
Ecole et Familles Oubliées, France
Bernice Figa, Founder of One Voice Group UK
Stacey McCann, Co-Founder of One Voice Group UK
Tony Dadd, Founder of Parents United UK
Gemma Sewell, Co-Founder of Parents United UK
David Lawrence, Founder of Contamination Concerns UK
Sarah LH Saul, parent and a founder of SafeEdForAll
Lisa Diaz, Parent & co founder of SafeEdForAll
Leah Brady, Parent, SafeEdForAll
Claire Cozler, Parent, SafeEdForAll
Caroline Lea, Parent, SafeEdForAll
Lili Stevens, Parent, SafeEdForAll
Dr PIetra Palazzolo, Parent, SafeEdForAll
Dr Marc Redmile-Gordon, Parent, SafeEdForAll
Dr Nicola Spiller, Parent, SafeEdForAll
Sarah Beauchamp, Parent, SafeEdforAll
Daniella Modos-Cutter, Parent, SafeEdForAll
Laura Scampioni, Parent, SafeEdForAll
April Booth, Parent, SafeEdForAll
Michelle Tierney, Parent, SafeEdForAll
James Lck, Parent, SafeEdForAll
Sughra Nazir, Parent, SafeEdForAll
Jasmin Amor, Parent, SafeEdForAll
Paul Hobden, Parent, SafeEdForAll
Martin Corless, Parent, SafeEdForAll
Nicky Hutchinson, Parent, Hive, SafeEdForAll
Nina May Peters, Director Founder, ShieldUs CIC
Emmy Jane Kelly Campaigns Manager, Northern Ireland Manager, ShieldUs CIC
Janty Marsden, ShieldUs CIC
Sally Marsden, ShieldUs CIC
Gemma Tilbury, ShieldUs CIC
Caroline Reid, ShieldUs CIC
Angela Davidson, ShieldUs CIC
Ethan Redmond, Mental Health Ambassador, ShieldUs CIC
Ian Watkinson, NEU National Executive
Adam Hamdy, Author
Damien Willey, Parent
Hilda Pamer, Parent, Grandparent, Greater Manchester Hazards Centre
Mrs R Gray
Ms Alison Price
Dr Rebecca Bateman
Ms A Aldridge
Daniela La Mancusa
R A Cousins (Educator)
Chiara Fontana Turner
Louise Springfield Horsfall
Ms Karen Clark
Anna di Giacomo
Mrs V Bailey
Miss Melanie doick
Dr. Sarah Peake
Stephen C Quinn
Mrs Michelle Kenwright
Mr Mark Kenwright
Mr & Mrs Bell
Mrs Natasha Court BA (Hons) QTS
Dr Samantha Coates
Dr Richard Coates
Miss D Cocksedge
Mrs B Cocksedge
Mrs Jane Rogers
Chris Storey, Parent, Winchester
Mrs A Podesta
Mrs Lisa Peace
Mr Simon Peace
— AUTHOR —
▫ Dr Deepti Gurdasani, Senior Lecturer in Epidemiology, Statistical Genetics, Machine Learning, Queen Mary University of London.
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[This piece was first published in PMP Magazine on 3 Sept 2021. | The author writes in a personal capacity.]
(Cover: Adobe Stock/Richard Johnson. / Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)