From March until September 2020 schools, colleges and universities had to rethink how to deliver their teaching. All educational establishments had to close their physical doors and move from face to face teaching to on-line tuition. With the one exception of key worker’s children (who continued to attend their schools in person to allow their parents to be able to work) students had to remain home.
In May 2020 this blog featured a piece called “Back to School” (click here to read) when the physical re-opening of schools was an emotive topic.
I wrote then that "the risks of not being in school may far exceed the risks from being back in school in terms of mental and physical health, emotional well being and education and that there was growing concern over the disadvantaged and vulnerable students who were being disproportionately affected by schools remaining shut."
At the time of writing case numbers of COVID-19 are climbing again and gatherings in England have been limited to no more than six people. Against this backdrop educational establishments are physically opening again and term has started, albeit with the new norms of social distancing, class bubbles and one way systems in corridors all in place.
The reality is that COVID-19 is going to be with us for some time with the WHO (World Health Organisation) warning that the pandemic remains a global emergency. Meanwhile UNESCO (The United Nations Educational, Scientific and Cultural Organization) has issued its own warning that more than half the world’s students have had their learning disrupted. (1) (2)
Remaining in lockdown until the virus is eradicated is not a viable possibility. The world is on the cusp of eradicating polio but it has taken decades to reach this point and we are not even close to eradicating diseases such as measles for which we already have an established vaccine. It is not realistic to wait for COVID-19 to go, solutions must be found to allow full time education to resume. (3) (4)
Schools
Across Europe schools have reopened with similar measures in place. Most are implementing staggered start and finish times, cohorts or “bubbles” of pupils that do not mix with other cohorts and an increased emphasis on hand washing and hygiene. Few countries have insisted on the compulsory wearing of masks in school with the exceptions of France and Italy where both pupils and children must wear masks throughout the day. (5)
In the UK most children returned to school in late August or early September which means it is too soon to assess the impact on COVID-19 rates. However, Public Health England commissioned research into the transmission rates in primary schools amongst those children attending in person in June and July. It found the risk of infection at school to be very low and that the cases that were identified had not contracted the infection within school nor had they passed it onto other children or staff in their schools. (6)
Although this study is helpful in assessing the risks to both children and teachers it was carried out at a time when class sizes were very small (though primary schools had reopened for Reception, Year 1 and Year 6) and did not include secondary schools. As normal schooling resumes researchers will continue to analyse any and all cases occurring in schools. Professor Paul Hunter from the University of East Anglia, told the Science Media Centre: “One of the particularly useful observations to come out of this new paper is that the probability of school outbreaks is related to the incidence in the general community.” (7)
Overall it seems that cases in schools are more likely to happen when there is a high number of cases in the surrounding community; in other words staff and pupils may be catching COVID-19 outside of the school and the school itself is not the main culprit in the spread of infection.
The European Centre for Disease Prevention and Control conducted surveys in European schools and reviewed the academic literature available and concluded that: “There is conflicting published evidence on the impact of school closure/re-opening on community transmission levels, although the evidence from contact tracing in schools, and observational data from a number of EU countries suggest that re-opening schools has not been associated with significant increases in community transmission.” (8)
In Jerusalem a major outbreak occurred in a high school affecting 153 students and 25 staff plus their contacts outside the school. At the time Jerusalem was experiencing a heatwave so masks were not worn and the ventilation system was used rather than opening doors and windows and it is thought that these factors contributed to the outbreak. (9)
The media has been quick to report COVID-19 cases linked to schools with headlines reporting “Dozens of outbreaks in schools.” However on closer analysis many of the outbreaks are reported as starting on the first or second day of term. Given that the incubation period for COVID-19 is at least five to six days (and can be up to fourteen days) any COVID-19 cases presenting in the first week of term will have been caught before going back to school, not at school. The geographical location of the schools with infections closely mirrors those areas of the UK with the highest COVID-19 outbreaks. Again this suggests that outbreaks in schools reflect what is happening in the wider community rather than schools themselves being the cause of an outbreak. (10) (11) (12)
The Chief Medical Officers for each of the UK nations issued a joint statement on 23 August 2020 where they acknowledged concerns about schools but said: “Because schools connect households it is likely opening schools will put some upward pressure on transmission more widely and therefore increase R. We have confidence in the current evidence that schools are much less important in the transmission of COVID-19 than for influenza or some other respiratory infections. Other work and social environments also increase risk and are likely to be more important for transmission of COVID-19.” (13)
Universities
“Without strong controls, the return to universities would cause a minimum of 50,000 deaths” was the alarming tweet (now removed) on the UCU (University and College Union) twitter page on 30 August 2020. The Union has also said that universities are at risk of becoming “the care homes of a Covid second wave.” [sic] (14)
The quote was taken from an unpublished research paper by a computer scientist at Swansea University. (15) However the author, Professor Alan Dix, was deliberately working on an assumption that there were no measures in place to stop the spread of the virus and the figure of 50,000 was based on every UK student catching COVID-19 and then spreading it to the wider community. When contacted by the charity "Full Fact" Professor Dix said: “this [50,000] death toll will not actually happen in its entirety, because once it became apparent it would trigger local or national lockdown, and/or the universities themselves being closed down.” (16)
This figure was taken from a mathematical model in which assumptions were made and was then tweeted out of context, however it continues to cause much alarm amongst students and their families.
The reality is that UK universities are working on a co-ordinated approach to managing the risk of COVID-19 infection whilst welcoming students back. Teaching will be a blend of on-line and face to face with social distancing in place. However, the main risk of infection does not lie with the teaching aspects of university but with the more social aspects of university life. Shared housing is the norm with first year students in particular living in communal halls of residence and social life typically involving larger gatherings. It should be born in mind though that the currently rapidly increasing case numbers in the UK are predominantly in the 17-24 age range, which may be the age range of most students, but the infection rate in this group started to climb before the universities re-started and reflects the ignoring of rules around parties and gatherings rather than students returning to university. (17) (18) (19)
Universities will face four tiers of restrictions depending on the background infection rate of COVID-19 in the local area. At Tier 1, the default tier, teaching will be a mixture of face to face and online through to Tier 4 which will all be online. (20)
The guidance also defines what counts as a student household. It will mean those sharing the same facilities (ie kitchen and bathrooms), usually no more than 12, rather than an entire block of student housing which could have over 100 students.
In the USA, there have been multiple outbreaks in universities across the country but a report in the BMJ (British Medical Journal) noted that universities in the states with high rates of community transmission fared far worse than those where community transmission was under control. There was also no co-ordinated federal plan for how to re-open the universities. As a result some were operating in their usual, pre-pandemic way only to have close two weeks later when COVID-19 cases soared whilst others have adopted a more cautious approach and are faring better. (21) (22)
As universities prepare to start their autumn term the UK government has restricted gatherings in England to no more than six people indoors or outdoors. Adhering to this new rule could be one of the best ways to stop students, and by default universities, finding themselves at the centre of subsequent outbreaks.
(1) https://www.france24.com/en/20200801-coronavirus-pandemic-will-be-with-us-for-a-long-time-who-warns
(8) https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission
(12) https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions
