COVID-19: SCHOOLS AS POTENTIAL SUPERSPREADERS. REALLY? (Update 23/8/20)

Watching last Friday's IndependentSAGE presentation, the term "superspreader" came up in relation to schools and the group's discussion document "What do we have to do to keep schools open?" in which they say:

• "The risk to children from COVID-19 is very low.", although:
• Children can suffer from LongCOVID in the form of MIS-C
• Risk rises as children get older, with older teens as likely to catch and spread COVID-19 as young adults 
•  "The kind of risk we are talking about here is the risk ...in terms of increased spread of COVID-19 in the community"

FROM A COMMUNITY PERSPECTIVE

They go on to say:

• "At a local level, there is ... clear evidence that re-opening any particular school can result in a local outbreak or cluster of infections. This is because school reopening makes a super-spreading event more likely by providing a space for very many people to mix over prolonged periods."

• Whereas "Where levels of local infection are very low, this remains very unlikely (because no one at the school is infected)"

• "In local hotspots where relatively many people are infected, schools provide a way for a single infected person to spread it to many others.  In countries where transmission is high or growing everywhere, school reopening is much riskier as every school could potentially host a super-spreading event."

• "Where community transmission of COVID-19 is low or controlled in a country as a whole, re-opening schools has little effect on increasing spread of COVID-19 nationwide"

Not surprisingly their first recommendation to let schools re-open safely, and stay open, is "reducing the level of virus circulating in the community to reduce the chance of schools triggering a super spreader event."

This echoes my own recommendation when I discussed various key risks in schools and universities that "The only way schools and Higher Education can re-open for all pupils and stay open is for the infection rate in each local community to be very low. Far lower than it is currently on average across England, let alone in hotspots such as the North West."


RISKS WITHIN A SCHOOL

Within a school, I have now summarised the key risks in a hierarchical diagram, which can provide the basis for a more detailed Risk Assessment.  This is only a first draft that can be modified as necessary to hghlight and rank the principal risks:

Update 23/8/20:

Here is a more detailed assessment of the risks in schools.

An interview with Professor Chris Whitty, the the UK's chief medical adviser, has just been published.  I fully agree with much of what he has said, especially:

• "The balance of risk [for the children] is very strongly in  favour of children actually going to school"
• "...parents meeting at the school gate for example." 
• "So the fact of schools being open will probably lead to some increase in transmission" as "The fact that schools are open allows more mixing of adults"

It's almost as if they have been reading my blogposts.

The interview reflects the contents of the full Concensus Statement by Prof Whitty and the Chief Medical Officers and Deputy Chief Medical Officers of England, Scotland, Northern Ireland and Wales.  The Statement is in three parts:

• Children
• Teachers, other school staff and parents
• Impact of opening schools on wider transmission (R)  

A number of other useful oints are made, but the conclusion is of most relevance "Early identification and quickly managing outbreaks of COVID-19 in schools is essential as part of a local response to COVID-19. Clear advice for pupils and staff not to attend school with symptoms, and prompt availability of testing, appropriate isolation advice, and careful public health surveillance and monitoring of educational establishments are key to support the safe return to schools."



But there are two aspects missing from the Statement, where they seem to be missing the evidence in this fast-changing world:

• No mention of LongCOVID for adults or children, for whom it is known as MIS-C "Multisystem Inflammatory Syndrome in Children"
• The experience of foreign schools as discussed below 
• Therefore to keep schools open, the general infection rate must be very low, #NearZero

FOREIGN EXPERIENCE OF OPENING SCHOOLS

I was shocked to hear that "Coronavirus cases have been reported by at least 41 schools in Berlin, barely two weeks after the German capital’s 825 schools reopened."  Two perhaps. But 41 ?!  Other places too.

To repeat what I said above fully two weeks ago, the only way schools and Higher Education can re-open for all pupils and stay open is for the infection rate in each local community to be very low. Far lower than it is currently on average across England, let alone in hotspots such as the North West.

That requires government action beyond the local lockdowns.