The lack of robust mitigation measures in schools puts children at greater risk of covid-19 infection and its consequences

To: 
The Rt Hon Gavin Williamson MP 
Secretary of state for education 
Department for Education 
20 Great Smith Street 
London
SW1P 3BT

Dear Mr Williamson,

We write as researchers, parents, and educators concerned about the impact of the pandemic on children’s education. Like you, and in agreement with the World Health Organization (WHO), we recognise the importance of schools staying open over the autumn and in the longer term. However, as the WHO also notes, schools must be made safe by adopting measures to minimise transmission of the SARS-CoV-2 virus. We are therefore writing to express our concerns about the lack of mitigations for children and educational staff, and the subsequent risk to children from covid-19 as schools reopen in England this September. We offer nine evidence based recommendations to reduce new infections in children. 

Children have suffered significant harms from covid-19. In just the past two months there have been over 2300 hospitalisations of under 18s in England. There are an estimated 34 000 children living with long covid in the UK already, with 22 000 reporting significant impacts on their day to day activities, 7000 of whom have had symptoms for more than a year (Office for National Statistics). Up to one in seven of those infected are expected to have persisting symptoms at 12-15 weeks. Long covid can be associated with multisystem disease in some children, including persistent cognitive symptoms. SARS-CoV-2 is a neurotrophic and pro-inflammatory virus with neuroinvasive potential that can infect the brain, with structural brain changes having been observed in adults, including those with mild infection. Allowing mass infection of children is therefore reckless. 

The evidence from Scotland and the USA, where schools reopened a few weeks ago, suggests that the lack of adequate mitigations will likely lead to infections spreading among children and significant absences due to student and staff illness, further disrupting learning.

Children are now returning to school against a background of community infection levels 26 times higher than at the same time last year, and with the much more transmissible Delta variant accounting for almost all infections. Currently, one in 50 primary school children and one in 40 secondary school children have prevalent infection (ONS) and we are experiencing 40-50 hospitalisations in under 18s every day. The Scientific Advisory Group for Emergencies (SAGE)  has warned that schools returning will likely lead to significant increases in cases in school age groups. This will coincide with increased pressure on the NHS over winter due to other respiratory viruses, and potentially alongside waning SARS-CoV-2 immunity among the most vulnerable. This puts everyone at risk, ​​and exacerbates the additional burden on people from disadvantaged areas, as well as those predisposed to more severe disease from Black and Asian communities. 

Both the European Centre for Disease Prevention and Control (ECDC) and the US Centers for Disease Control and Prevention (CDC) have recommended vaccination of teenagers, together with a combination of measures such as masking, small bubbles, testing, and improved ventilation in schools this autumn to keep children safer and in education. England has not followed this advice. There has been no plan for robust mitigation measures in schools to reduce the risk to children from infection and the consequences thereof, including long covid, hospitalisations, staff safety, and educational disruption. In England there is no requirement for masks, bubbles, physical distancing, or contact tracing within schools.

Despite MHRA approval, the UK Joint Committee on Vaccination and Immunisation (JCVI) has not yet recommended vaccination of all 12-15 year olds, and their recommendation to vaccinate 16-17 year olds has come too late to complete vaccination of adolescents before they return to schools, despite clear evidence that benefits far outweigh risk at current levels of infection. Meanwhile, over 12 million under 18s have been vaccinated across the world.

England’s policies mean that we will soon have a large susceptible population with a high prevalence of infection mixing in crowded environments with hardly any mitigations. 

The government has a duty to protect children, our wider communities, and the NHS and healthcare workers from the impact of a fourth wave following schools re-opening. We suggest a nine point plan to achieve this:

1. Offer vaccines to all 12-15 year olds, with roll-out in schools to maximise access and uptake.
2. Immediately reinstate face coverings for secondary school students and staff in classrooms and communal areas as long as community transmission remains high, with provision by your department of high grade masks to schools.
3. Urgently invest in both building ventilation and supplemental ventilation in schools by provision of air filtration devices as needed, with CO₂ monitoring of indoor spaces to ensure that targets are met.
4. Reinstate bubbles, this time with appropriate maximum sizes to minimise educational disruption, while properly containing transmission.
5. Reinstate contact tracing by schools with a strict policy on mandatory isolation and PCR testing of all contacts of cases (in bubbles or households) to prevent onward spread.
6. Improve financial and practical support for self-isolation as this will improve uptake of rapid tests in schools.
7. Provide remote learning options and support, including wifi, tablets, and/or laptops for clinically vulnerable children, children living in households with clinically vulnerable members, and those required to self-isolate.
8. Remove mandatory attendance policies and prosecutions and fines for parents, so that a parent can make a choice of learning modality that is in the best interests of their child.
9. Provide mental health support in schools for students and staff.

The above measures should be implemented alongside multi-layered public health measures to reduce community transmission, which will also reduce the potential for outbreaks in educational settings, allowing children to remain in schools safely.

Deepti Gurdasani, Queen Mary University of London, UK
Yaneer Bar-Yam, New England Complex Systems Institute, USA, Founder World Health Network
Spiros Denaxas, University College London, UK
Trisha Greenhalgh, University of Oxford, UK
Stephen Griffin, University of Leeds, UK
Zubaida Haque, Independent SAGE, UK
Zoë Hyde, University of Western Australia, Australia
Aris Katzourakis, University of Oxford, UK
Martin McKee, London School of Hygiene & Tropical Medicine, UK
Susan Michie, University College London, UK
Christina Pagel, University College London, UK
Stephen Reicher, University of St. Andrews, UK
Alice Roberts, University of Birmingham, UK
Christopher Tomlinson, University College London, UK
Kit Yates, University of Bath, UK
Hisham Ziauddeen, University of Cambridge, UK

Competing interests: Zubaida Haque, Martin McKee, Susan Michie, Christina Pagel, Stephen Reicher, and Kit Yates are members of Independent SAGE. Nothing further declared.

On behalf of the full list of co-signatories listed below.

Scientists and healthcare professionals:

Dr. Deepti Gurdasani, Queen Mary University of London, UK
Dr. Hisham Ziauddeen, University of Cambridge, UK
Prof. Susan Michie, University College London, UK
Prof. Christina Pagel, University College London, UK
Dr. Zubaida Haque, Independent SAGE, UK
Prof. Trisha Greenhalgh, University of Oxford, UK
Dr. Stephen Griffin, University of Leeds, UK
Prof. Martin McKee, London School of Hygiene & Tropical Medicine, UK
Dr Eric Feigl-Ding, Federation of American Scientists, US
Dr. Zoë Hyde, University of Western Australia, Australia
Prof. Aris Katzourakis, University of Oxford, UK
Dr Kit Yates, University of Bath, UK
Prof. Stephen Reicher, University of St. Andrews, UK
Dr Joe Pajak, FRSC, CSci, NHS Foundation Trust Governor, UK
Prof. Yaneer Bar-Yam, New England Complex Systems Institute, USA, Founder World Health Network.
Dr. Christopher Tomlinson, University College London, UK
Prof. Alice Roberts, University of Birmingham, UK
Dr Eilir Hughes GP, Fresh Air Wales
Dr. Alison George, GP, UK
Prof. KK Cheng, University of Birmingham, UK
Prof. Carlos Gershenson, Universidad Nacional Autónoma de México
Greta Fox, FNP-BC, COVID Action Group, World Health Network
Prof. Spiros Denaxas, University College London, UK
Prof. Matthias F Schneider, Technical University of Dortmund, Germany
Dr S A Aftab, Chair BMA Yorkshire Consultant Committee, NHS Foundation Trust Governor, UK
Prof. Sunil Raina, Head, Community Medicine, Dr. RP Govt. Medical College, India, World Health Network
Cécile Philippe, economist, Institut économique Molinari, World Health Network, France
Dr. Gunhild Alvik Nyborg, researcher, Covid Action Group, Norway
Joshua P Cohen, health economist, independent healthcare analyst, Boston, Massachusetts
Margo Watroba, strategist, Business Economist, New England Complex Systems Institute, World Health Network, USA
Elisa Zeno, research engineer, France
Dr. Michaël Rochoy, University of Lille, France
Prof Andrew Ewing, University of Gothenburg, Sweden
Dr. Asit Kumar Mishra, NUI Galway, Ireland
Dr. Jonathan Howard, associate professor of neurology and psychiatry at NYU and chief of Neurology service at Bellevue hospital

Organisations

One Voice Support Group for CV & CEV Families UK
Parents United UK
Contamination Concerns During Covid-19 UK
SafeEdForAll
Shields CIC
Hazards Campaign
World Health Network
Covid Action Group
Ecole et Familles Oubliées, France

Parents/Carers/Educational staff

Bernice Figa, Founder of One Voice Group UK
Stacey McCann, Co-Founder of One Voice Group UK
Tony Dadd, Founder of Parents United UK
Gemma Sewell, Co-Founder of Parents United UK
David Lawrence, Founder of Contamination Concerns UK
Sarah LH Saul, parent and a founder of SafeEdForAll
Lisa Diaz, Parent & co founder of SafeEdForAll
Leah Brady, Parent, SafeEdForAll
Claire Cozler, Parent, SafeEdForAll
Caroline Lea, Parent, SafeEdForAll
Lili Stevens, Parent, SafeEdForAll
Dr PIetra Palazzolo, Parent, SafeEdForAll
Dr Marc Redmile-Gordon, Parent, SafeEdForAll
Dr Nicola Spiller, Parent, SafeEdForAll
Sarah Beauchamp, Parent, SafeEdforAll
Daniella Modos-Cutter, Parent, SafeEdForAll
Laura Scampioni, Parent, SafeEdForAll
April Booth, Parent, SafeEdForAll
Michelle Tierney, Parent, SafeEdForAll
James Lck, Parent, SafeEdForAll
Sughra Nazir, Parent, SafeEdForAll
Jasmin Amor, Parent, SafeEdForAll
Paul Hobden, Parent, SafeEdForAll
Martin Corless, Parent, SafeEdForAll
Nicky Hutchinson, Parent, Hive, SafeEdForAll
Nina May Peters, Director Founder, ShieldUs CIC
Emmy Jane Kelly Campaigns Manager, Northern Ireland Manager, ShieldUs CIC
Janty Marsden, ShieldUs CIC
Sally Marsden, ShieldUs CIC
Gemma Tilbury, ShieldUs CIC
Caroline Reid, ShieldUs CIC
Angela Davidson, ShieldUs CIC
Ethan Redmond, Mental Health Ambassador, ShieldUs CIC
Ian Watkinson, NEU National Executive
Lisa Clark
Bex Hopkins
Amy Wolfs
Catherine Wilson
James Marrinan
Steve McCann
David Wolfs
Georgina Jobling
Chris Sewell
Adam Hamdy, Author
Sherrill Stroschein
James Neill
Susan Foster
Sue Wedlock
Ruth Poerscout-Edgerton
John Poerscout-Edgerton
Chris Fabby
Esther Hopkins
Kim Wareham
James Wareham
Ellie Burton
Tanya Berry
Damien Willey, Parent
Hilda Pamer, Parent, Grandparent, Greater Manchester Hazards Centre
Kirsty McNeil
Louise Richards.
Sam Groves
C Davey
Shelley Diment
Christina Janusz
Russell Flint
Emma Adams
Debra Kelly
Peter Kelly
KM Stubbs
Shelley Nicholson
Alida Hussey
Nichola Brown
Jeannette Griffiths
Mrs Daly
Christine Mattless
Emma Batista
Liesje Bargh
William Hutchinson
Chloe Leckie
Natalie Darby
T Tuttlebee
Janine Dye
Claire Hurley
Elaine Pembro
Bex Broadhurst
Jay Waller
Neil Waller
Sharon Case
Lian Kent
Leah Waller-Hill
Gemma Payne
Mrs R Gray
Elizabeth Hipkiss
Robert Fay
C Howard
Lisa Russ
Rebecca Mitchell
Toli Kram
Ms Alison Price
Rachel Chapman
L Tarrant
Caroline Hanson
Josephine Unwin
A Brayford
Susan Fairbrother
Dr Rebecca Bateman
Claire Murphy
Alan Dunn
Kate Gill
Eleanor Hipkiss
Chris Iremonger
Shelley Wilson
J Dyer
Rebecca McCarter
Paula Buckley
Kirstie Morton
Natalie Collings
Ian Blackmore
Michele Stansfield
Hazel Boaler
Kerry Knight
David Boaler
Leonie Graham
Victoria Stone
Pamela Palmer
S Graham
L Mason
C Symons
Rebecca Dennison
N Oliver
Amanda Whittaker
Ms A Aldridge
Karen Moody
Shaun Moody
Joanna Buckmaster
Rose Stevens
AM Boom
Fatima Ali
Jennifer Chileshe
Lisa Welsh
Katherine Cromwell
Daniela La Mancusa
D Harrison
C Cook
Tara T
Vera Silva
R A Cousins (Educator)
Chiara Fontana Turner
Louise Springfield Horsfall
Joanne Richardson
Liz Heads
Roberta Rivieccio
Stephanie Salgado
L Wilson
Adrian Taylor
Carmen Lau
Ms Karen Clark
Natalie Nelmes
Katherine Knights
Ms Harrison
Anna di Giacomo
Kate Dinmore
Neil Dinmore
Tamara Devereux
Abby Brigden
Amanda Jackson
J Hayter
T Calvert
David Holt
Lisa King
Mrs V Bailey
Natalie Darby
Tabbie Hunt
L Protheroe
Emma Kelly
Amy Blewitt
Miss Melanie doick
Dr. Sarah Peake
Steve Quinn
Amy Doig
Stephen C Quinn
Anna James
Karen Hayden
Simone Todd
Sarah Holland
Candice Glenday
Violet Smith
Laura Smowton
Soma Meran
Julie Skinner
Mrs Michelle Kenwright
Mr Mark Kenwright
Kerstin Ward
Mr & Mrs Bell
Mrs Natasha Court BA (Hons) QTS
Hazel Broadie
Mary Eley
Donna Malena
Ben Kilpatrick
Karen McCafferty
Olga Kilpatrick
John McCafferty
T Cumming
Rebbecca Rusling
Phil McGinity
L.Munns
J Claydon
D Claydon
M Pearson
R Pearson
Sarah Huntington
Samantha Towler
Joanne Richardson
Peter Richardson
Jessica Bedford
Drew Gervais
Carol Bray
Michelle John
Laura Huish
Michelle Ritter
Dr Samantha Coates
Dr Richard Coates
Miss D Cocksedge
Mrs B Cocksedge
Mrs Jane Rogers
Chris Storey, Parent, Winchester
Mrs A Podesta
Darcey Podesta
Jodie Power
Belinda Sullivan
Sonia Sandhu
Raaj Purohit
Suzanne Hall
Joanna Trigg
Shaun Young
Diana Ball
Sarah Gibson
Jonathan Gibson
L Barrett
Lorna Hunter
Natalie Knightley
Mrs Lisa Peace
Mr Simon Peace
Jacqui Barker
J Richardson
Pat Turnbull