UPDATE 29 May 2020
The situation in Denmark remains reassuringly stable after analysis of their data for the last five weeks showed no rise in COVID-19 cases as lockdown restrictions have eased. Their schools reopened on 15th April and, after a small initial rise in new cases, numbers have steadily declined.
Dr Peter Andersen, from the Infectious Disease Epidemiology and Prevention unit at the Danish Serum Institute, told Reuters news agency that “You cannot see any negative effects from the reopening of schools.”
He also went on to say that the initial increase in cases that happened at the same time as the schools reopened was "too early to have anything to do with the reopening and could be explained by an increase in tests performed." (1)
Primary schools in the UK will begin a phased reopening on 1st June. Although schools have remained open for certain groups of children, namely vulnerable children and those of key workers, 99% of the nation's school children have been at home during lockdown with many participating in on-line learning. (2)
Data from other European countries who have eased their lockdowns several weeks ahead of the UK should be available soon. (3)
Original Piece 20 May 2020
The most emotive topic at the moment is centred on the re-opening of schools and nurseries in the UK. Opinion is divided between those who feel it is a vital next step in the easing of lockdown and those who see it as exposing the nations’ children and teachers to unnecessary risks. Whilst schools have remained open for the children of keyworkers and some vulnerable children, less than 1% of the nation's children have been at school during lockdown. (1)
The situation was complicated further when the BMA (British Medical Association) first said it did not support the re-opening of schools and then backtracked on this and dropped its opposition. (2)
Without doubt deciding when schools should reopen is difficult. Remaining closed until there are zero COVID-19 cases is not viable as the virus is highly likely to be with us in one way or another for the next 1 to 2 years, though that does not mean the pandemic remains at its height all that time. Infections may subside and then re-emerge in localised pockets of activity according to leading researchers. (3)
The risks of not being in school may exceed the risks from being back in school, especially for vulnerable and disadvantaged children who are being disproportionately affected by schools remaining shut.
Decisions are made by balancing the risks, something people do every day without realising. Although a car journey could result in an accident, a walk could result in a fall and a broken leg or a trip to a restaurant could result in food poisoning, these are such familiar risks people are able to balance them and make reasoned decisions knowing that it is far more probable they will not have an accident, break a leg or get food poisoning.
The same is true with illness and disease. We send our children to school knowing they will be exposed to coughs and colds, chickenpox and various other childhood ailments. We take holidays in far flung places knowing they expose us to diseases that we never encounter at home such as malaria. However, what marks these apart from COVID-19 is they are known risks we feel familiar with and we know how to manage them. Coughs and colds are simply a part of life and we can be vaccinated against many serious illnesses before going abroad.
The difference with COVID-19 is that it is new. Just six months ago none of us had heard of it but in that time is has brought entire nations to a standstill.
The unknown is always more frightening than the known and a generally unhelpful media capitalise on this with headlines such as “Corona as deadly as Ebola in hospital” and “Coronavirus Covid-19 could kill 45 million – and ‘poses bigger threat than terrorism’”. Little wonder that parents and teachers alike are worried about the children returning to school.
(4) (5)
What do we actually know?
There is growing evidence that the risk to individual children from Covid-19 is extremely small but no united view on how likely it is that children can spread the virus.
In April 2020, a joint study by University College London (UCL), London School of Hygiene and Tropical Medicine, Cambridge University and Sydney University concluded that school closures had very little effect on controlling the pandemic. (6)
However, scientists in Wuhan, China where the pandemic began concluded that, whilst school closures alone could not stop the infection spreading, their closure had a role to play in lowering the R number (you will find an explanation of the R number here).
Looking to other nations who are now several weeks into re-opening their schools will become vital a source of information to aid UK decision making. Twenty two European countries have begun reopening their schools, all with strict social distancing policies in place. Although nowhere is reporting an associated sudden new rise in cases, most have only opened within the last two weeks so it is too early to draw firm conclusions. The two exceptions are Denmark and Norway where schools have been open for five and four weeks respectively.
Denmark
Denmark was the first country in Europe to start reopening its schools on 15th April. Classes have been broken up into smaller groups with desks 2 metres away from each other, more time is spent outdoors, including some lessons being taught outside, and there is an increased emphasis on hygiene and handwashing.
The R number rose during the first two weeks of the schools reopening (from 0.7 to 0.9) but then fell again. The number of both new cases and deaths each day has continued to fall since. Parents did not have to send their children back but the majority did, either at the very beginning of reopening or within the first two weeks. (7) (8)
Norway
Norway began re-opening its schools on 20th April, but with a very different structure to the school day. The pupils are split into smaller groups of no more than 15 who rotate through a timetable of attending school at different times to each other and when at school the groups do not interact with each other. Parents are not obliged to send their children back but most have. The number of new cases and deaths is consistently falling in Norway and there has been no spike in numbers since the schools went back. (9) (10) (11)
Transmission fears
Understandably the biggest parental fear is that children going back to school will acquire COVID-19 themselves and transmit it back to the home. With illnesses such as flu or vomiting bugs this is often the case but children do not appear to be targeted in the same way by the COVID-19 coronavirus.
In places where large numbers of people have been randomly tested for the virus few, if any, children under the age of 10 tested positive even when other family members did.
In the Italian town of Vo’, 86% per cent of the population were tested and there were no cases in the under-10s, despite the fact a number of them lived with adults who had tested positive for Covid-19. (12)
John Edmunds, a professor at the London School of Hygiene and Tropical Medicine told the House of Lords Science Committee that it was “unusual that children don't seem to play much of a role in transmission because for most respiratory viruses and bacteria they play a central role, but in this they don't seem to."
He also went on to say "There is only one documented outbreak associated with a school - which is amazing; you would normally expect most of the outbreaks to be associated with schools but yet in global literature there is only one documented study." (The school concerned was a French secondary school.)
Dr Rosalind Eggo, also from the London School of Hygiene and Tropical Medicine, advises caution though and told the same committee that "There are hints that children are less infectious but it is not certain,” and underlined the need for more studies to “really pin this down as it is so important." (13)
Risks of Not Reopening Schools.
Not being in school carries educational, social, health and well-being risks.
Lack of education
A Canadian study in 2013 showed school closures of just four weeks had a major negative impact on a child’s education with the biggest decline seen in maths. (14)
The Sutton Trust, a UK educational charity, has been surveying teachers and parents during the lockdown period and has found that secondary school pupils of less affluent and disadvantaged households are less likely to be taking part in online lessons with just 16% participating compared to a UK total of 30% overall of all secondary school pupils. If only private schools are looked at this rises to 57%.
It has warned that the differences between private and state schools are increasing rapidly but divisions are also widening within the state sector where the less well-off pupils are falling behind the most. (15)
Natalie Perera, the head of research at the Education Policy Institute said “The way in which children are learning at the moment is massively variable. There’s no consistency and there’s no framework from the government about what should be expected.” (16)
The concern now is how such a huge disruption to their education can be resolved and if next year’s (2021) GCSE and A-level exams should take into account the fact some pupils have continued to have regular on-line teaching during lockdown whilst others have had none.
Wellbeing
During lockdown the vital safeguarding aspect of schools has been lost. One child a week dies from neglect or abuse in the home according to the NSPCC (National Society for Prevention of Cruelty to Children). (17)
Children at risk of abuse in the family home are no longer visible at school. For these children school is often their only safe space. This, combined with heightened tensions in the home because of lockdown and its restrictions and financial losses, has led many children’s charities to express concern that the longer school closures continue the greater the risk to vulnerable children. (18)
Mental and Physical Health
1 in 8 children has a mental health disorder and the rates are higher where families are struggling. Doctors are reporting seeing increased numbers of mental health crises caused in part by the lockdown. (19) (20)
For some children school is the only place where they get a proper meal and physical exercise. Friendships and social interactions are a vital part of health and children are missing out on these at present.
These adverse effects on their mental and physical health could remain with some children lifelong and the longer they are out of school, the more severe these effects could become.
Is there a Right Way to Reopen Schools?
The Department of Education has laid out its guidance for the reopening of schools in the UK from 1st June at the earliest. These are based on the current understanding about COVID-19 transmission and disease severity in children and allow individual authorities and schools to set their own measures within the parameters laid out. The document is detailed but in essence recognises that the local prevalence of COVID-19 (how many cases there are locally) and the ability of any one school to set workable social distancing and infection control measures will influence which schools reopen, when and how. (21)
It is likely that UK schools will implement many of the ideas from Denmark and Norway such as keeping pupils in smaller groups that are kept in their own “bubbles” all day, having more breaks for hand-washing, one way systems in school corridors and a staggered school day to keep the number of pupils on site at any one time low.
In Conclusion
The emerging picture in Denmark and Norway tentatively suggests that reopening schools does not cause a resurgence of COVID-19 cases. Within the next two weeks we should know if that picture has been repeated in other European countries who began reopening their schools at the beginning of May.
The science is not yet conclusive but there is cautious optimism that reopening schools does not pose an increased risk to children or staff. More research on this will become available in the very near future.
Not reopening schools carries substantial risks of its own to pupils, especially vulnerable and disadvantaged pupils.
When schools here in the UK start to reopen it will be a gradual process and the structure of the whole day will have to be guided by workable, practical social distancing measures. Parents will have the right to keep their child away from school when they reopen and will not be penalised for doing so.
There is no risk-free way of easing any part of lockdown, only a balancing of risks. With hindsight we now know that our schools were open completely as normal when COVID-19 cases were increasing in the community and the pandemic was taking hold. As the children return to school, the case numbers are falling and the most restrictive measures will be in place to try and keep it that way.
(1) https://www.thetimes.co.uk/article/coronavirus-one-in-20-eligible-children-go-to-school-5c8gffj3d
(3) https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part1_0.pdf
(17) https://learning.nspcc.org.uk/research-resources/statistics-briefings/child-deaths-abuse-neglect