Boris Johnson has argued that reopening schools in September with full attendance is necessary to restart the economy. He has subsequently put more emphasis on the concept that keeping schools closed is ‘morally indefensible’. However, given that the number of new infections is slowly rising, have realistic plans been put into place?
School closures have been part of the control measures implemented in many countries. It is impossible to quantify the precise contribution of school closures to the reduction of coronavirus infections, as other measures were implemented at the same time.
Closing schools has resulted into a wider adoption of home learning. However, not all children have access to a quiet place to study or to an electronic device at home. A UK survey has reported that home learning works better for secondary school children and for higher income families.
Will schools need to be closed again if infection numbers rise? On the one hand children are less likely to acquire this infection and usually have milder symptoms. But on the other hand there is a greater risk of severe infections for children with certain conditions (respiratory, cardiac or neuro-disability) as well as for adult school staff and adult relatives of the pupils.
The limited information in the medical literature suggest that school outbreaks are infrequent and small when mitigation strategies and reduced attendance are in place. However, the risk seems higher in secondary schools and would increase with a full reopening. Large secondary school outbreaks have been reported in both France and Israel when no or inadequate controls were in place. An unpublished study by Public Health England appears to show that there is a significant risk in secondary schools.
In terms of overall infection numbers, it may be possible to compensate for the reopening of schools by shutting down other venues, such as pubs, or through an overhaul of our inadequate test and trace system leading to a more effective contact tracing.
Recognition of infection cases in schools may be poor as many children do not have the symptoms described in the UK guidance for children (high fever, persistent new cough, loss of smell or taste) but may present with other symptoms such as rhinorrhoea or sore throat or even gastrointestinal symptoms (diarrhoea, vomiting). The US CDC has done a better job in describing the wider range of symptoms.
The spread of coronavirus in schools can be limited with control measures. However, the measures proposed for our schools do not appear to be quite robust enough.
The UK has relaxed the requirement for a minimum one metre distance. Conversely, a one metre distance is still required in Italian schools and, when this distance between desks is not achievable, Italian schools have been asked to use external venues such as cinemas or exhibition centres.
In addition to this, Italian secondary schools (equivalent to our year 10 and above) can complement teaching in the school with home learning, as a reduced daily attendance allows more social distancing. Vouchers to purchase laptops have been made available for lower income families. Older pupils who are more capable of independent learning can stay at home without parental supervision.
Face masks will also be mandatory in Italy for pupils of all ages at least until when they have reached their desks. Teachers and at-risk children can keep the masks on during lessons. Some Italian headteachers have ordered face shields for their staff as they are more comfortable to wear over prolonged periods of time. Worryingly, there are no similar arrangements in the UK.
In the US a 15-year old posted an image on social media of secondary school students packed in a school corridor, some without masks. Cases of coronavirus infection were subsequently reported in six students and three members of staff.
In Israel the reopening of schools in May was followed by a large outbreak in a secondary school and 240 other schools were subsequently closed when they had cases. The chairman of the team advising Israel’s National Security Council has come to similar conclusions as the Italian experts: schools need two metres distances between desks, smaller classes and face masks.
School closures have had a more severe impact on the educational attainment of children from deprived communities and this has been used by some to argue for a full school reopening without carefully planned safeguards. However, deprived communities also have a higher coronavirus mortality and the lockdown was critical in curtailing excess deaths. In a secondary school from the North East region 40 students have lost loved ones during the coronavirus first wave.
The issue is not whether to reopen schools but how to reopen them safely. The current arrangements are not as safe as they could be and may not be sustainable in the face of rising infection numbers.