{"id":49516,"date":"2021-02-03T12:44:58","date_gmt":"2021-02-03T11:44:58","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49516"},"modified":"2021-02-09T13:26:21","modified_gmt":"2021-02-09T12:26:21","slug":"covid-19-and-schools-known-unknowns","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/02\/03\/covid-19-and-schools-known-unknowns\/","title":{"rendered":"Covid-19 and schools\u2014known unknowns"},"content":{"rendered":"<p><i><span style=\"font-weight: 400\">On 28 January The BMJ hosted a webinar on covid-19 and schools. An expert panel discussed the risks of <\/span><\/i><i><span style=\"font-weight: 400\">community transmission to students and teachers, the clinical risks of covid-19 for children, the mental health effect of school closures, and international perspectives<\/span><\/i><i><span style=\"font-weight: 400\">. <\/span><\/i><b><i>Nikki Nabavi<\/i><\/b><i><span style=\"font-weight: 400\"> and <\/span><\/i><b><i>Juliet Dobson<\/i><\/b><i><span style=\"font-weight: 400\"> report<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">The theme of the webinar was inspired by an editorial published in <\/span><i><span style=\"font-weight: 400\">The BMJ<\/span><\/i><span style=\"font-weight: 400\"> called \u201c<a href=\"https:\/\/www.bmj.com\/content\/371\/bmj.m3979\">Covid-19\u2019s known unknowns<\/a>.\u201d The key message: \u201cthe more certain someone is about covid-19, the less you should trust them.\u201d<\/span><\/p>\n<p><iframe loading=\"lazy\" title=\"COVID-19 and schools: #CovidUnknowns\" width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/OOpH9mbiGnQ?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/p>\n<p><b>Community transmission<\/b><\/p>\n<p><span style=\"font-weight: 400\">Alasdair <\/span><span style=\"font-weight: 400\">Munro, <\/span><span style=\"font-weight: 400\">clinical research fellow in paediatric infectious diseases, Southampton University,<\/span><span style=\"font-weight: 400\"> began the discussion by defining the difference between \u201ctransmission\u201d (infection passed on from one person to another) and \u201cprevalence\u201d (number of people infected at a given time).<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cWhen we refer to young children, we&#8217;re normally talking about primary school age children and below. That is an important differentiator because there are some biological and epidemiological differences between young children and adolescents,\u201d he said. This was later picked up on by Muge Cevik, clinical lecturer in infectious diseases, St Andrews, who suggested that in primary schools, children are often clustered tightly in their classrooms, whereas secondary school kids mix much more broadly, not only with other classrooms, but also have more afterschool contacts. Munro added: \u201cGiven the much larger population within secondary schools, the possibility of having very large outbreaks is bigger because there are simply more people who could potentially become infected if there were a large super spreading event.\u201d<\/span><\/p>\n<p><b>Susceptibility to infection<\/b><\/p>\n<p><span style=\"font-weight: 400\">\u201cIn England, what we saw around November, December time when schools were fully open and the rest of the society was under restrictions, was an increase in cases among kids compared with adults,\u201d says Cevik.<\/span><\/p>\n<p><span style=\"font-weight: 400\">According to Munro, the best way to ascertain susceptibility to infection is through household contact tracing studies, as it can be assumed that everyone within a household has similar types of exposure. \u201cMost of the studies have been well conducted and tested all contacts regardless of their symptom status, which is important as it eliminates a potential bias for children who may have a lower symptom burden.\u201d He cited <a href=\"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2771181\">a meta-analysis in JAMA Paediatrics<\/a>, which shows that the relative risk odds of a child having been infected in a household is roughly half of that of an adult. Cevik agreed that contact tracing data show that\u00a0 working age adults are more likely to bring infection to the household than children.\u00a0<\/span><\/p>\n<p><b>Clinical risks to children<\/b><\/p>\n<p><span style=\"font-weight: 400\">Elizabeth Whittaker, senior clinical lecturer in paediatric infectious diseases and immunology, explained\u00a0 that the risk of both hospitalisation and death from covid-19 is very low in children\u2014those in hospital are mostly younger than 1 year or older teens.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Some children have been affected by a chronic fatigue-like syndrome (fatigue driven with no evidence of end organ damage), whereas others have had paediatric inflammatory multisystem syndrome (PIMS, a post infectious phenomenon defined as \u201cchild presenting with persistent fever, inflammation, and evidence of single organ or multiorgan dysfunction, exclusion of any other microbial cause, and a history of SARS-Cov-2, or contact).\u201d A third of these children develop severe disease and need emergency treatment, often ending up in intensive care. \u201cThese children are often negative on swab for the virus with the PCR test, but have already made antibodies, fitting with that epidemiological picture that this is a post-infectious phenomenon.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">According to Whittaker, in the second wave, clinicians were much better at recognising PIMS early and initiating appropriate treatment, although a proportion of these children developed similar symptoms as adults with long covid.<\/span><\/p>\n<p><b>Clinical risk to teachers<\/b><\/p>\n<p><span style=\"font-weight: 400\">According to Rachael Woo<\/span><span style=\"font-weight: 400\">d, <\/span><span style=\"font-weight: 400\">consultant in public health medicine,<\/span> <span style=\"font-weight: 400\">\u201cthe General Teaching Council for Scotland has provided [Public Health Scotland] with basic demographic details for almost all active teachers in Scotland, and NHS organisations have provided similar data for healthcare workers.\u201d This allows assessment of risk to teachers\u00a0 and healthcare workers separately from the general working age population. Findings have been reassuring for teachers, as there is now \u201cstrong evidence\u201d that teachers are at a similar or lower risk of severe illness or dying from covid-19, than the general working age population, \u201cand that finding persists when schools are open.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Wood reminded attendees\u00a0 that similar or low risk is not no risk, and that the risk of covid for teachers reflects the background risk in the communities and populations in which they live.<\/span><\/p>\n<p><b>Infectiousness<\/b><\/p>\n<p><span style=\"font-weight: 400\">Munro stated that infectiousness has been much more difficult to ascertain in children, who they can still infect others, even when asymptomatic.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cIt&#8217;s important to emphasise that [transmission] depends on various factors\u2014it is not only one dimensional,\u201d says Cevik. \u201cFor example, in England, we saw much more outbreaks in secondary schools in the most deprived areas. Those kids might be living in much more crowded and multigenerational households that are also at higher risk of infection outside of the household.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Munro explained why tracing infectiousness in children can be especially complicated, as a result of their shared exposure with classmates. \u201cFor example, you find a child case A who is infected, you test their contact, B, who is also infected, and you assume that A has infected B, whereas what has actually happened was A and B were together at the time they were exposed to C (the initial infectious person). Then we don&#8217;t know if C infected A and B, if C infected A, who infected B or C infected B, who infected.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Cevik added\u00a0 \u201cWhen schools are open, there&#8217;s evidence to suggest in school transmission, and that these are stochastic events . . . There are still many unknowns, especially the impact of schools on community prevalence, hospitalisations, and deaths . . .How and when to open close schools is not solely a scientific decision, because I think schools provide more than education.\u201d<\/span><\/p>\n<p><b>Impact of school closures<\/b><\/p>\n<p><span style=\"font-weight: 400\">Elisabeth Gilpin, the headteacher of St Mary Redcliffe School, one of the largest secondary schools in Bristol, started the session by pointing out that \u201cschools are not closed.\u201d As well as real time remote learning, \u201cchildren are on site\u201d because they \u201care vulnerable, perhaps because of their special needs or their home circumstances.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Gilpin highlighted the emotional trauma that covid-19 is having on young people, saying that \u201c<\/span><span style=\"font-weight: 400\">our country is going through a pandemic and so there are so many more bereavements . . . parents are more anxious, perhaps because of potential job losses, and children will be soaking up all this trauma.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">According to Sunil Bhopal, <\/span><span style=\"font-weight: 400\">NIHR academic clinical lecturer in paediatrics at Newcastle University:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cWe&#8217;ve been causing great harm in many ways to children through our pandemic response,\u201d he said, \u201cis this harm justified by the benefits brought about towards pandemic control?\u201d \u201cSchools matter not just for education and learning, but for everything else. Children need children. They need to spend time with them for socialisation and interaction,\u201d Bhopal said. \u201cWhen one in four young people are saying that they feel unable to cope with life, I worry.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Bruce Adamson, children and young people\u2019s commissioner for Scotland, agreed that\u00a0 \u201c<\/span><span style=\"font-weight: 400\">this has been the biggest human rights crisis that we faced in a very long time.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Haroon Chowdry, Director of Evidence for Children\u2019s Commissioner England, talked about how worried children are: <\/span><span style=\"font-weight: 400\">.\u201d \u201cChildren talk about how they feel like they&#8217;ve been blamed for covid . . . they feel like they&#8217;re being blamed for spreading it.\u201d\u00a0<\/span><\/p>\n<p><b>International perspectives<\/b><\/p>\n<p><span style=\"font-weight: 400\">Ibukun C Akinboyo, <\/span><span style=\"font-weight: 400\">professor of paediatrics at <\/span><span style=\"font-weight: 400\">Duke University Hospital, North Carolina, US, discussed the data driven approach that she and her colleagues have taken to measure and inform their response to covid-19. <\/span><span style=\"font-weight: 400\">\u201cWe saw very few, not zero, very few secondary cases.\u201d Where they saw cases, she said, \u201cwe adjusted, and we haven&#8217;t seen secondary spread. So it is possible to have in-person education safely during a pandemic. It&#8217;s certainly not the panacea for all of our problems, but we should have ongoing discussion.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Margrethe Greve-Isdahl from the Institute of Public Health in Norway, discussed the Norwegian strategy. The country\u2019s\u00a0 schools closed in March 2020 and <\/span><span style=\"font-weight: 400\">gradually started reopening by the end of April\u2014a lot earlier than many other countries.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">A \u201ctraffic light\u201d system helped. From May to November, the yellow level was sustained. But when cases rose from the end of October measures were tightened, but schools remained.<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cBut we have also had a lot of communication relating to staying home when sick and implementing hygiene measures. And we are one of the few countries that have been able to avoid masking in schools, either for teachers or pupils at any age,\u201d she said.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Armand Fontanet, Pasteur Institute, explained that France\u2019s <\/span><span style=\"font-weight: 400\">president and minister of education are very much pro school opening. Nevertheless, schools were closed in France from March until May.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In May, schools resumed, but with \u201cquite tough restrictions. We put masks on all kids from the age of 6and above, and things went OK. . . . a\u00a0 few outbreaks here and there, but nothing really major,\u201d Fontanet said. Over autumn, France went into lockdown, but kept schools open.<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, now the new variants of covid-19 and the experience from other parts of Europe is causing concern. Fontanet: \u201c I really cannot tell you what decision will be made . . . schools\u00a0 will be probably the last thing that the president will agree to close.\u201d<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><strong>This webinar was part of <a href=\"https:\/\/www.bmj.com\/covid-19-webinars\"><em>The BMJ<\/em>&#8216;s series of covid-19 known, unknowns webinars<\/a>. Find out more and register for future events here.\u00a0<\/strong><\/p>\n<p><em><strong>Nikki Nabavi<\/strong>, editorial scholar, The BMJ<\/em><\/p>\n<p><em><strong>Juliet Dobson<\/strong>, editor bmj.com, The BMJ<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: none declared.<\/em><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">&#8212;<\/span><\/p>\n<p><span style=\"font-weight: 400\">Panel and Agenda<\/span><\/p>\n<p><b>Community prevalence\/ transmission\/ dissemination\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Chair: George Davey Smith, Bristol University<\/span><\/p>\n<p><span style=\"font-weight: 400\">Alasdair Munro, University of Southampton<\/span><\/p>\n<p><span style=\"font-weight: 400\">Muge Cevik, University of St Andrews<\/span><\/p>\n<p><b>Clinical risks (severe disease\/long covid)\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Chair: Allyson Pollock, Newcastle University<\/span><\/p>\n<p><span style=\"font-weight: 400\">Risks to children: Elizabeth Whittaker, Imperial College, London<\/span><\/p>\n<p><span style=\"font-weight: 400\">Risks to teachers: Rachael Wood, Public Health Scotland and David McAllister, University of Glasgow<\/span><\/p>\n<p><b>Impacts of school closures\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Chair: Caroline Relton, University of Bristol<\/span><\/p>\n<p><span style=\"font-weight: 400\">Teachers\u2019 perspective: Elisabeth Gilpin, St Mary Redcliffe School, Bristol,<\/span><\/p>\n<p><span style=\"font-weight: 400\">Consequences for children: Sunil Bhopal, Newcastle University<\/span><\/p>\n<p><span style=\"font-weight: 400\">Rights of the child:<\/span><\/p>\n<p><span style=\"font-weight: 400\">Bruce Adamson, Children and Young People\u2019s Commissioner for Scotland<\/span><\/p>\n<p><span style=\"font-weight: 400\">Haroon Chowdry, Director of Evidence for Children\u2019s Commissioner England<\/span><\/p>\n<p><b>International perspectives<\/b><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Chair: Fiona Godlee, The BMJ<\/span><\/p>\n<p><span style=\"font-weight: 400\">USA: Ibukun C. Akinboyo, Duke University Hospital<\/span><\/p>\n<p><span style=\"font-weight: 400\">Norway: Margrethe Greve-Isdahl, Institute of Public Health, Norway<\/span><\/p>\n<p><span style=\"font-weight: 400\">France: Arnaud Fontanet, Pasteur Institute<\/span><\/p>\n<p><span style=\"font-weight: 400\">North America\/ Europe: Jennifer Couzin-Frankel, Science Magazine<\/span><\/p>\n<p><b>Discussion<\/b><\/p>\n<p><span style=\"font-weight: 400\">Chair: Phil Hammond, Gp, Journalist and Broadcaster<\/span><\/p>\n<p><span style=\"font-weight: 400\">&#8212;<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>On 28 January The BMJ hosted a webinar on covid-19 and schools. An expert panel discussed the risks of community transmission to students and teachers, the clinical risks of covid-19 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/02\/03\/covid-19-and-schools-known-unknowns\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":48237,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18932,116],"tags":[],"class_list":["post-49516","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-covid-19-known-unknowns-webinars","category-editors-at-large"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Covid-19 and schools\u2014known unknowns - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/02\/03\/covid-19-and-schools-known-unknowns\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Covid-19 and schools\u2014known unknowns - The BMJ\" \/>\n<meta property=\"og:description\" content=\"On 28 January The BMJ hosted a webinar on covid-19 and schools. An expert panel discussed the risks of community transmission to students and teachers, the clinical risks of covid-19 [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2021\/02\/03\/covid-19-and-schools-known-unknowns\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2021-02-03T11:44:58+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2021-02-09T12:26:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/coronavirus_schools_lockdown_PA-54477423.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"julietwalker\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"julietwalker\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/\"},\"author\":{\"name\":\"julietwalker\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/373707d32533c2cbca204980b8cd3493\"},\"headline\":\"Covid-19 and schools\u2014known unknowns\",\"datePublished\":\"2021-02-03T11:44:58+00:00\",\"dateModified\":\"2021-02-09T12:26:21+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/\"},\"wordCount\":1752,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/coronavirus_schools_lockdown_PA-54477423.jpg\",\"articleSection\":[\"Covid-19 known unknowns webinars\",\"Editors at large\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/\",\"name\":\"Covid-19 and schools\u2014known unknowns - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/coronavirus_schools_lockdown_PA-54477423.jpg\",\"datePublished\":\"2021-02-03T11:44:58+00:00\",\"dateModified\":\"2021-02-09T12:26:21+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2021\\\/02\\\/03\\\/covid-19-and-schools-known-unknowns\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/coronavirus_schools_lockdown_PA-54477423.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/08\\\/coronavirus_schools_lockdown_PA-54477423.jpg\",\"width\":540,\"height\":350,\"caption\":\"Children's drawings of rainbows and messages of support for the National Health Service (NHS) cover the windows of a primary school in the Lancaster Gate neighbourhood of London, England, on July 6, 2020. England took major steps towards the resumption of normal life over the weekend with the easing of coronavirus lockdown restrictions on the hospitality sector, allowing bars and restaurants to reopen, plus a shift to a 'one-metre plus' social distancing rule. Covid-19 deaths across the whole UK meanwhile now stand at 44,236, including a further 16 recorded today. 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