When should British schools reopen? Here's what the science tells us
The big debate over the past few days has been whether it’s safe to open schools to children other than those those of key workers or classed as vulnerable. However, this isn’t quite the right question to be asking. There will never be no risk. In a world where Covid-19 remains present in the community, it’s about how we reduce that risk, just as we do with other kinds of daily dangers, like driving and cycling. What we should be asking is whether schools are safe enough to open. To answer this, of course, you have to have data. What is needed to inform decisions is information and real-time monitoring, at the local level, to tell us what the daily number of new cases and rate of transmission is. Those concrete numbers should be what drives policy, not a set of abstract arguments, even less an ideological battle.
In the absence of this data, the proposal to reopen schools in England on 1 June remains controversial among teaching unions, the British Medical Association, staff and parents alike. Our view is that schools should reopen as soon as possible, but this must form part of a larger system of “test, trace and isolate” strategies, proper support and full transparency about the trade-offs involved and the large scientific uncer
tainty.
That scientific uncertainty surrounds two key questions: the first is the degree to which children can transmit the virus to teachers and parents. The second is the number of children likely to develop a severe multisystem inflammatory syndrome several weeks after exposure to coronavirus. A recent study in the Lancet found a thirtyfold increase in children presenting with this condition in Lombardy, Italy, and the research team warned that other countries experiencing Sars-CoV-2 outbreaks would probably also see a rise in cases. The numbers were small and the evidence suggests that the syndrome is likely to be uncommon but, given that we still don’t have data on exactly how many children have been exposed to the virus, we can’t make a calculation as to how rare it actually is.
Elsewhere, we see that Denmark, Norway, Germany and New Zealand are starting to reopen their schools, which raises the question of why those countries might be in a position to do so while the UK is not. Politicians desperate for answers point to a preliminary study from New South Wales in Australia that found that “close contact” in schools resulted in very little transmission. However, one major caveat is that research was conducted during a period when attendance had dropped to 5%, enabling true physical distancing. In addition, early widespread implementation of community testing, contact tracing and isolation of carriers across the country has helped to manage the number of cases. Australia is therefore easing its lockdown against a background of solid control of the virus. The lesson from there and other nations with similarly effective regimes is that the UK needs to suppress the virus and ensure that public health infrastructure is ready to detect new infections and identify clusters rapidly.
Given the difficulties around maintaining physical distance in overcrowded state schools, we need to identify innovative strategies involving the use of larger spaces, phased re-entry, or both. In Denmark, some schools have made use of spaces, such as a football stadium, that aren’t currently being used. This may be a particularly useful tool in major cities with larger schools and class sizes. Germany has asked older children to return first, while New Zealand and Israel have prioritised the return of children who are from vulnerable homes, younger children who require adult supervision or pupils who have learning difficulties. The decision to prioritise younger pupils – because the early years are fundamental to reducing educational inequalities – or to focus on older pupils – because they are better able to follow physical distancing rules and have exams and graduation ahead – is a political one.
Flexible thinking is key to balancing the competing demands of safety and educational need. In the UK this could mean schools returning early from the summer holidays. Schools in New Zealand and Thailand have revised the dates of holidays for the remainder of the calendar year to make up for the teaching time lost during the lockdown. All signs point to this virus hitting hard in the coming winter as flu season begins and activity moves largely indoors. We should make optimum use of the summer months to get schools prepared and able to function, alongside a strong public health infrastructure.
Given the higher number of coronavirus cases and active community transmission in the UK, a conservative, locally managed approach to schools reopening seems wise. For example, a system whereby the rate of transmission and the number of daily new cases in a given area must be below a set level before schools can reopen could be implemented – and then only if “test, trace, isolate”, social distancing, and hygiene and surveillance measures are in place. These conditions should be agreed in consultation with teachers and school heads, and public health, child psychology and education experts.
The tragedy is that the countries that moved the fastest and “crunched the curve” are those that never had to close schools, or are in a strong position to reopen them quickly. While the number of daily Covid-19 deaths grabs headlines, we must not forget the children experiencing hunger from loss of school meals, those living in abusive households and the widening educational deficit. While many scientific and logistical questions remain, what’s clear is that children, especially those from disadvantaged backgrounds, are truly paying the price for the UK government’s poor decisions over the past 12 weeks.
• Devi Sridhar is chair of global public health at the University of Edinburgh. Ines Hassan is a researcher at the Global Health Governance Programme at the University of Edinburgh