“It will be vital to explain why and how school reopening is safe.”
That key word, “safe”, figured repeatedly in evidence on the safety and impact of reopening schools gathered by the UK government’s scientific advisory group, Sage, which was published in late May (and from which the above quote is taken).
And the government has certainly taken up the advice of using that word in arguing why schools should remain largely closed to most pupils. Indeed, many people have adopted that language, too, stating that schools should “only open” when they are “safe”.
But what about the “how” and “why” bit of the Sage advice? What does “safe” actually mean?
- The science behind school closures
- What is the most infectious place in a school?
- How all Dutch primary pupils are back in school
When it comes to the government’s prospects of explaining that any further reopening of schools this term would be “safe”, that ship has already sailed. In fact, that ship has sailed, hit an iceberg, plunged to rock bottom, then exploded, then exploded again.
However, as thoughts turn to fuller reopening in the autumn term, the issue of safety, and how it is defined, will continue to be a crucial one.
Coronavirus: what does 'safe' mean?
Some of the key “safety” factors were highlighted in a recent report on reopening schools published by the Independent Sage, a group of “preeminent experts” formed to challenge what it sees as the government’s failure to be transparent about the scientific advice it has received from the official Sage.
“We believe that decisions on school opening should be guided by evidence that there are low levels of Covid-19 infections in the local community in which the school is situated and the ability to rapidly respond to new infections through a well-functioning, coordinated, local test, track and isolate strategy,” said the Independent Sage, chaired by former UK government chief scientific adviser Sir David King, in the report.
“We have seen no compelling evidence that these conditions have so far been met across the country.”
Test and trace
The reason why testing and tracking is seen as a key factor in reopening schools takes us back to the original reason why so many governments closed schools: not, primarily, because of fears about the health of children (who, overwhelmingly, do not tend to become ill from the virus), but because closing schools severs contacts across all age groups (there are adults in schools too, you may have noticed) and thus reduces virus transmission.
So, without an effective testing and tracking system to isolate and contain infections, the fear is that having schools open and thus multiplying social contacts across age groups could set in motion a second wave of the virus.
Nations that have successfully reopened schools “had a more comprehensive find, test, trace and isolate system up and running at the time they opened schools,” and “had a lower amount of community circulating virus when opening schools,” says Deenan Pillay, professor of virology at University College London, Independent Sage member and former Sage member.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine (LSHTM), another Independent Sage member, agrees. Nations that have been able to open schools to a fuller extent have “well-functioning find, test, trace, isolate, support systems – we [the UK] have a fragmented test and trace”.
Many of those nations had “smaller classes to begin with”, while Denmark, a notable success in reopening schools, has “invested heavily in new facilities and [is] also making lots of use of outdoor teaching”, he adds.
Across a number of factors, the situation in the UK “is not remotely comparable” to that in a nation such as Denmark, argues McKee.
Impact of school closures
Meanwhile, a pre-print paper published at the start of June by an international team of academics – including Sage member and UCL professor in adolescent health Russell Viner – modelled the spread of coronavirus in the UK under four different scenarios for reopening schools, ranging from all schools reopening fully in June, through phased reopenings, to all schools reopening fully in September.
This modelling “suggests that a phased reopening is safe as long as this is in the broader context of a well-functioning test-trace-isolate system in which 80 per cent of symptomatic cases are tested and 40 per cent of the contacts of these are traced,” says one of the paper’s authors, Chris Bonell, professor of public health sociology at LSHTM, a member of the government’s Scientific Pandemic Influenza Group on Behaviours.
Stop me if you’ve heard this one before, but Bonell adds: “The system in the UK is not currently achieving these levels.”
Preventative measures in schools
Bonell and Viner are also among the authors of a separate paper, currently under review for publication, looking at another aspect of safety – measures against transmission that can be implemented within schools through behavioural change and protection.
That paper aims to provide initial steps towards a comprehensive strategy on changes such as keeping pupils in a single class group throughout the day, including at breaktimes; intensive cleaning programmes; one-way systems; and education for pupils on hygiene and distancing.
Together, the authors say, these measures in schools can “offer a means of disrupting SARS-CoV-2 [the official name of the coronavirus] transmission via routes involving fomites [surfaces], faeco-oral routes” – we’re all in particular favour of disrupting that one – “droplets and aerosols”.
And yet, some scientists take a different view on safety. After closing at the start of the pandemic, Dutch primary schools have been partially open since 11 May and are now fully open, while secondary schools have been partially open since 2 June.
The National Institute for Public Health and the Environment (RIVM) Outbreak Management Team, which advises the Dutch government, has actually “never advised school closure because of the limited role of children in transmission”, says Wim van der Hoek, head of the RIVM Department for Respiratory Infections. “Schools were closed anyway because of societal pressure,” he says.
The Dutch government, a multiparty coalition led by centre-right prime minister Mark Rutte, responded to the initial fears of parents with closures, then subsequently began a two-week trial reopening of primary schools in May, which did not result in any outbreaks.
The RIVM has also published data showing that only 0.6 per cent of reported Covid-19 hospitalisations in the Netherlands involved children under the age of 18.
Good to talk?
But while the scientists believed schools were “safe”, what was the key to persuading the Dutch public it was safe to reopen schools: having a testing and tracking regime in place alongside low transmission rates in the community, or research showing children do not play a major role in transmission?
Andreas Voss, professor of infection control at Radboud University and a member of the RIVM Outbreak Management Team, says it has been “kind of all” of those factors, “and later mainly our own [RIVM] data on transmission between parents and young children showing that transmission [on the occasions when children do become infected] is mainly from adults to children and rarely the other way round”.
In the Netherlands, this approach ensured government and teaching unions were on the same page.
Linda van Druijten, who leads De Boomhut and OBS De Klaproos, a primary school and special educational needs school in Arnhem, says that after the RIVM data and the successful test of partial reopening, the majority of teachers said, “‘We want to go back to the classroom, we want to go back to our jobs’…So I think that’s why the unions are more mellow about this topic.”
As a school leader, does she feel she has been consulted by the government on reopening?
“Definitely, yes. I’m very proud of how the unions and the prime minister did their jobs,” replies van Druijten.
She adds that 35 schools in Arnhem joined together to form a “corona team” liaising with government agencies, “and all the time they [government agencies] asked the school leaders, ‘what do you think about this, what do you think about that?’ – so a lot of consensus again.”
When contrasted against the consensus achieved in the Netherlands, the deficiencies of the UK’s approach are stark.
But perhaps, in addition, the concept of “safety” being discussed in this country is too narrow and should go beyond health into the broader welfare of children.
Allyson Pollock, clinical professor of public health at Newcastle University and another member of the Independent Sage, agrees that “we need track and trace” in helping to reopen schools.
But highlighting concerns about children “being denied their right to education for three months” and the particular impact on those from disadvantaged backgrounds, she adds: “In a way, I don’t like this question, ‘Is it safe for schools to open?’…[The right question is], what is required in order to make sure that children have the access to the educational, social and cultural opportunities they need?”
Answering that question would involve “really being imaginative” on creating day summer camps and open-air schools, opening up sports stadia and private school playing fields to all children, while also addressing the role that Private Finance Initiative contracts can play in preventing some state schools from opening facilities outside of standard hours and in holidays, Pollock suggests.
Safe to return?
Even researchers whose work has supported the effectiveness of school closures back a fundamental reshaping of the UK’s approach to the issue.
Paul Hunter, professor in medicine at the University of East Anglia’s Norwich Medical School, was lead author on a paper that suggested closure of educational institutions had “by far the biggest impact” of any individual lockdown measure across 30 European nations.
However, he says: “We’ve got to get schools back, at least in the autumn term. The question is, can teachers, public health experts and the government agree a strategy for ensuring that children’s education can continue in a way that isn’t going to unnecessarily put the lives of either the children – or more likely the children’s grandparents and so on – at risk?”
More information needed
Like many other scientists, he sees an effective test, track and trace regime as an essential step towards reopening schools. But Hunter also calls for much greater transparency around the government’s scientific advice, and a fuller and more open debate among scientists.
He thinks these aspects will be crucial “if you’re going to reassure teachers – and effectively you’ve got to, because if anybody’s going to die from an infection acquired in a school, it’s going to be a teacher rather than a child, really.”
Hunter adds: “The Department of Health and the Department for Education should be really looking at how they can build a consensus around this.”
An injection of Dutch consensus, and clarity of communication, could help treat the UK’s maladies on reopening schools. But that treatment will be unpalatable to plenty in power here, given Westminster’s highly centralised, oppositional culture and the Conservative party’s continued attachment to seeing teaching unions as an enemy to be defeated, rather than as one of several legitimate interest groups within schools.
As so often with the pandemic crisis, the debate over the safe reopening of schools exposes much that is unhealthy about the UK’s politics, where both supply and demand for consensus remain depressingly low.
John Morgan is a freelance journalist