Why send 200 pupils home over one positive Covid test?

If every positive test leads to whole year groups being sent home, schools face massive disruption, warns Sunil Bhopal

Sunil Bhopal

Coronavirus: Do schools really need to ask whole year groups to self-isolate?

Educating the next generation is, in my view, one of the most important tasks of any society. I think that schools matter more than virtually anything else.

And so I was very glad to hear Anne Longfield, the children’s commissioner for England, calling for schools to be “last to close, and first to reopen”, in response to future Covid-19 challenges. 

So I’m rather aghast to hear that, for medical and public health reasons, whole year groups – sometimes hundreds of pupils – are being sent home from their schools when a single child tests positive for Covid-19.

Coronavirus: Understanding the risks

It goes without saying that this pandemic must be controlled. Doctors, public health officials, politicians, schools and teachers – we’re all on the same side here. 

But the questions for me as a paediatrician are: what does a proportionate response to different types and severity of a Covid-19 school outbreak look like? What does government guidance say? How is this being interpreted by schools and local public health teams? And, finally, does this guidance need to be amended for clarity and consistency?

We’re now nine months into this pandemic. We’ve learned a lot and the risks are much better understood. Indeed, the risk faced in schools today in the UK is not the same as the lesser-known risks back in March. 

We’ve learned that it’s mainly older adults who have been severely affected. And the evidence we have to date suggests that spread is driven mainly by adults, not by children

Defining 'close contact'

Schools have done a fantastic job to get up and running again after a tough six months of uncertainty. The crucial issue that seems to have emerged in these first few weeks back at school is: what should be done when a child or adult in school tests positive for Covid-19?

The aim is to isolate anyone who has been very close to that person and may have become infected themselves – what we might call a “close contact”. 

The problem seems to be the specific definition of “close contact” and the implementation of isolation policies by schools and local public health teams. Current practice appears to be highly variable throughout the country, and speedy action is needed now to gather all the evidence on decisions that have been made, and the rationales behind them

Everyone working on this will have great intentions, and it’s key that guidance allows them to act in a proportionate way. Teachers, governors and schools should feel able to engage with local public health teams to ensure that responses to Covid-19 cases take into account the local reality.

'Government needs to provide funding'

Teachers ask me online, what about school staff? I say that, first of all, they should certainly be distancing from each other – bearing in mind that five metres is better than two, and that most transmission is adult to adult. 

But they should also be protected by their employer. In particular, those staff who are most vulnerable should be very strongly looked after. These are likely to be those who are older – say, over 60 years – or those with severe or life-limiting medical conditions. Government needs to provide funding so that this can happen.

But we have to remember that there’s no such thing as zero risk – of course, there never has been. Teachers and other school staff are right for not wanting to contract Covid-19: who would want this? But staff, especially younger ones – say, for the sake of argument, the under-40s – need to be allowed to consider Covid-19 compared with other risks we view as part of normal life, like influenza and road-traffic accidents.

I’d suggest that there should be a different approach for people at different levels of risk – and most of that risk has to do with age.

A winter of constant exclusions

Remember that a positive test doesn’t necessarily mean a person is infectious: dead fragments of the virus can sit around for quite some time. 

If we continue down this road of every positive Covid-19 test leading to a whole year-group exclusion, we’re going to be in for a winter of constant exclusions, with massive disruption to education. 

We need the Department for Education to come together with the chief medical officer and public health colleagues to come up with really clear guidance about how contact tracing and school exclusion should be done. 

At the moment, it’s being done differently in different places, and we can’t really say that schools are open if this exclusion situation continues – or even worsens.

For clarity, what I’m not saying is to throw all caution to the wind – not at all. I’m just saying: schools are so important that we must be proportionate. Where we know that an infectious child hasn’t come into contact with all 200 pupils in their bubble, we should exercise caution and keep educating. 

Some people will, of course, be part of the child’s contact group, and will definitely come within the category of a close contact. Then there will be some who perhaps sit on the opposite side of the classroom, and whom they never speak to: we wouldn't expect those to need to be excluded. And then there are those in the middle, and schools and public health teams, of course, have a really difficult decision to make about those children.

As I’ve argued through this pandemic, we must put children first.

Dr Sunil Bhopal is academic clinical lecturer in population health paediatrics at Newcastle University and NHS speciality registrar in community paediatrics. He tweets as @sunilbhop

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Sunil Bhopal

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