{"id":50423,"date":"2021-06-11T08:59:01","date_gmt":"2021-06-11T07:59:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50423"},"modified":"2021-06-16T18:00:55","modified_gmt":"2021-06-16T17:00:55","slug":"covid-19-and-the-delta-variant-we-need-an-urgent-focus-on-mitigations-in-schools","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/11\/covid-19-and-the-delta-variant-we-need-an-urgent-focus-on-mitigations-in-schools\/","title":{"rendered":"Covid-19 and the delta variant\u2014we need an urgent focus on mitigations in schools\u00a0"},"content":{"rendered":"<p><span style=\"font-weight: 400\">On the 17 May 2021, the UK government removed the requirement for face coverings in secondary schools in England. [<\/span><span style=\"font-weight: 400\">1]<\/span><span style=\"font-weight: 400\"> Writing in <\/span><i><span style=\"font-weight: 400\">The BMJ<\/span><\/i><span style=\"font-weight: 400\"> on 14 May 2021, <\/span><span style=\"font-weight: 400\">we argued that this was ill advised given the clear evidence for the role of children and schools in transmission of SARS-CoV-2 and the rise of the new variant, subsequently designated as delta, which was already implicated in school outbreaks at the time. [2-4]<\/span><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">There has been a lack of transparency from Public Health England (PHE) around the spread of the delta variant in schools. On 22 May, an article in <\/span><i><span style=\"font-weight: 400\">The Observer<\/span><\/i><span style=\"font-weight: 400\"> reported that these data had been withheld by PHE at the request of 10 Downing Street. [<\/span><span style=\"font-weight: 400\">5]<\/span><span style=\"font-weight: 400\"> On 31 May 2021, The Citizens, a group promoting accountability in public life, and the data rights firm AWO sent a pre-action letter warning that they would seek judicial review unless PHE published the data<\/span><span style=\"font-weight: 400\"> on the grounds they it had acted \u201cunlawfully\u201d by withholding data on the spread of the variant in schools, and had \u201csurrendered its independent judgement.\u201d [6]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Concerningly, even now, PHE has failed to release the full data. In a detailed technical report released on the 3 June, it only provided data on the number of \u201cincidents\u201d or outbreaks involving two or more students in schools. [<\/span><span style=\"font-weight: 400\">7]<\/span><span style=\"font-weight: 400\"> It did not provide numbers of delta variant cases linked to schools, which had been specifically and repeatedly requested by unions and scientists, and specified in the pre-action letter. Despite including several complex analyses, the 66-page report presented no breakdown of cases by age group. [<\/span><span style=\"font-weight: 400\">7]<\/span><span style=\"font-weight: 400\"> However, even the limited data provided on school outbreaks raises concerns. According to the report, 140 outbreaks of the delta variant had been identified in educational settings up to 30 May, the largest number in any of the settings specified. [<\/span><span style=\"font-weight: 400\">7]<\/span><span style=\"font-weight: 400\"> The data on \u201ccommon exposures\u201d (defined as two or more infected children with sequenced virus) for the week ending 11 May, just prior to dropping recommendations for masks in schools, showed that there were over 1000 common exposures for children infected with the delta variant in educational settings. [<\/span><span style=\"font-weight: 400\">7]<\/span><span style=\"font-weight: 400\"> Additionally, data from PHE<\/span><span style=\"font-weight: 400\"> and Office for National Statistics (ONS)<\/span><span style=\"font-weight: 400\"> showed that the highest overall infection rates were among secondary school age children. [8,9]<\/span><\/p>\n<p><span style=\"font-weight: 400\">PHE has continued to put out contradictory claims. [<\/span><span style=\"font-weight: 400\">10]<\/span><span style=\"font-weight: 400\"> Just a day after reporting that infection rates were currently highest in 10-19 year olds,<\/span><span style=\"font-weight: 400\"> it claimed that cases among school-age children were low. [11,<\/span><span style=\"font-weight: 400\">12]<\/span><span style=\"font-weight: 400\"> This contradicted other ONS data released the same day that showed rapid rises in prevalence in this age group, with this now being much higher than all other groups. [<\/span><span style=\"font-weight: 400\">9]<\/span><span style=\"font-weight: 400\"> A day later the health secretary Matt Hancock stated that a \u201chuge proportion of latest cases are in children.\u201d This is reminiscent of messaging by the government from autumn and winter 2020 where the mantra \u201cschools are safe\u201d was used repeatedly to rationalise the lack of mitigations in schools, right up to the point they were closed on 5 <\/span><span style=\"font-weight: 400\">January (following a day when many schools reopened briefly). At that point the Boris Johnson, the UK prime minister described them as \u201cvectors for transmission, causing the virus to spread between households.\u201d [<\/span><span style=\"font-weight: 400\">13]<\/span><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Back to the present, the government has finally acknowledged the high rates of infection and transmission in children. As with its many previous errors, there is no acknowledgement that it has not followed advice from its own advisors. [<\/span><span style=\"font-weight: 400\">14]<\/span><span style=\"font-weight: 400\"> The government has left children, staff, and communities exposed to rapid spread of a new and more transmissible variant, and at risk of long covid. [<\/span><span style=\"font-weight: 400\">15]<\/span><span style=\"font-weight: 400\"> Yet, even as we see absenteeism related to covid-19 rising in schools,<\/span><span style=\"font-weight: 400\"> with 31% children absent from secondary schools in Bolton, the government\u2019s messaging remains focussed on rapid tests. [16] This is despite dropping uptake over time,<\/span><span style=\"font-weight: 400\"> and clear evidence that tests alone have not been able to contain spread in schools. [8] Even after acknowledging the risks of infection and transmission in children, there is still no emphasis on urgent mitigations,<\/span><span style=\"font-weight: 400\"> including masks and ventilation, that are vital if schools are to remain open. [17] While we welcome the health secretary&#8217;s announcement that children may be eligible to be vaccinated in August<\/span><span style=\"font-weight: 400\"> this does not help right now. [18] According to SAGE modelling, the current wave is expected to peak in late July. [<\/span><span style=\"font-weight: 400\">19]<\/span><span style=\"font-weight: 400\"> By that time thousands of children and their family members will have been affected.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Data from Bolton, and several other places, <\/span><span style=\"font-weight: 400\">where the delta variant gained dominance suggested early on that infection spread first among school age children, and then to other age groups. [10,20] It is likely that lack of mitigations in schools played an important role in this highly transmissible, more virulent,<\/span><span style=\"font-weight: 400\"> escape variant <\/span><span style=\"font-weight: 400\">gaining dominance rapidly across England. [7,21,22] Spread of the delta variant is likely to have played an important role in the exponential rises we are seeing of cases in England, and hospitalisations in North West England. [<\/span><span style=\"font-weight: 400\">23]<\/span><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">During the current crisis the focus on the Stage 4 re-opening on the 21 June by government and media detracts from actions that need to be taken immediately to pre-empt the potentially devastating impact of a third wave. Our concern here has been with the actions that must be taken in schools to keep our children safe.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">First<\/span><\/i><span style=\"font-weight: 400\">, we must reintroduce masks both at primary and secondary levels and both in classrooms and communal areas. Unions have jointly called for an immediate re-introduction of masks in secondary schools<\/span><span style=\"font-weight: 400\"> and several local authorities have already reinstated these. [16] This needs to be incorporated into Department for Education guidance as a recommendation for all schools.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">Second<\/span><\/i><span style=\"font-weight: 400\">, there needs to be central investment in ventilation and air cleaning in schools, including CO2 monitors, and air filtration devices, to supplement ventilation where needed. Risk can also be reduced by moving to learning outdoors, where possible, including physical education activities.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">Third<\/span><\/i><span style=\"font-weight: 400\">, there must be practical, financial, and remote learning support for families with children who are isolating. And lastly, the Government must provide adequate catch-up resources for children who have lost out on education over the past year, to bridge gaps and worsening inequities in education.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In sum, schools are the place where infections are rising fastest. Yet schools are a place where the basic mitigations of face coverings, space, and fresh air are not simply missing, but\u2014in the case of masks\u2014have actually just been removed. This makes no sense. The government must act urgently to protect and support its children at this critical juncture.\u00a0<\/span><\/p>\n<p><b><i>Deepti Gurdasani,\u00a0<\/i><\/b><i>senior lecturer in machine learning, Queen Mary University of London.<\/i><\/p>\n<p><em><b>Hisham Ziauddeen,\u00a0<\/b>consultant psychiatrist,\u00a0Cambridge and Peterborough NHS Foundation Trust, UK.<\/em><\/p>\n<p><em><strong>Stephen Reicher<\/strong>, professor, School of Psychology and Neuroscience, University of St. Andrews. Member of Independent SAGE and\u00a0<\/em><em>the advisory group to the Scottish chief medical officer.\u00a0<\/em><\/p>\n<p><b><i>Martin McKee,\u00a0<\/i><\/b><i>professor of European public health at the London School of Hygiene and Tropical Medicine.\u00a0<\/i><i>Member of Independent SAGE.\u00a0<\/i><\/p>\n<p><span style=\"font-weight: 400\"><strong>References<\/strong>:<\/span><\/p>\n<ol>\n<li><span style=\"font-weight: 400\">Gov.uk. Face coverings no longer required in schools and colleges from 17 May. 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Gurdasani D, Pagel, C., Yates K., McKee M., Greenhalgh T. . Is the government \u201cfollowing the data\u201d on face coverings in schools? <\/span><i><span style=\"font-weight: 400\">BMJ Opinion<\/span><\/i><span style=\"font-weight: 400\"> 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">First cases of Indian variant Covid-19 found in Leicester. Leicester News. 28 April 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Indian Covid &#8216;variant of concern&#8217; found in education settings in Bedford. Bedfordshire Live News. 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Cadwalladr C. No 10 \u2018tried to block\u2019 data on spread of new Covid variant in English schools. The Observer. 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Silva CD. Government faces legal challenge over \u2018unlawful\u2019 suppression of Covid data in schools. The Independent. 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Public Health England. SARS-CoV-2 variants of concern and variants under investigation in England: Technical briefing 14, 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Public Health England. Weekly national Influenza and COVID-19 surveillance report Week 22 report (up to week 21 data) 3 June 2021, 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Office of National Statistics. Coronavirus (COVID-19) Infection Survey, UK: 4 June 2021, 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Pagel PC.@chrischirp; 2021.<\/span><a style=\"background-color: #ffffff;font-size: 1rem\" href=\"https:\/\/twitter.com\/chrischirp\/status\/1400757535158775809?s=20\">https:\/\/twitter.com\/chrischirp\/status\/1400757535158775809?s=20<\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">Public Health England. @PHE_uk. This week&#8217;s #COVID19 surveillance report shows that case rates are highest in those aged 10-19 years old; 2021. https:\/\/mobile.twitter.com\/PHE_uk\/status\/1400437277189447683<\/span><\/li>\n<li><span style=\"font-weight: 400\">Public Health England. Our latest data shows that #COVID19 outbreaks linked to #school settings &amp; cases among school-age cohorts have remained low and broadly reflected what is happening in the wider community. @PHE_uk. <\/span><a href=\"https:\/\/twitter.com\/PHE_uk\/status\/1400751272706330625\"><span style=\"font-weight: 400\">https:\/\/twitter.com\/PHE_uk\/status\/1400751272706330625<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\">Elgot J WP. England to enter toughest Covid lockdown since March. The Guardian. 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Sample I QB, Adams R. Pupils should keep wearing masks into the summer, Sage told ministers. 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Office of National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Weal S AR. Unions call for return of masks to secondary classrooms in England. The Guardian. 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Gurdasani D, Alwan NA, Greenhalgh T, et al. School reopening without robust COVID-19 mitigation risks accelerating the pandemic. <\/span><i><span style=\"font-weight: 400\">Lancet<\/span><\/i><span style=\"font-weight: 400\"> 2021; <\/span><b>397<\/b><span style=\"font-weight: 400\">(10280): 1177-8.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Malnick E. Vaccines for children could start in August under plans being discussed by ministers. The Telegraph. 2021<\/span><\/li>\n<li><span style=\"font-weight: 400\">University of Warwick: Roadmap scenarios and sensitivity \u2013 steps 3 and 4, 5 May 2021<\/span><\/li>\n<li><span style=\"font-weight: 400\">Gov.uk. Coronavirus (COVID-19) in the UK: Cases in Bolton.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Bernal JL AN, Gower C, Gallagher E, Simmons R, Thelwall S, Tessier E, Groves N. Effectiveness of COVID-19 vaccines against the B.1.617.2 variant. <\/span><i><span style=\"font-weight: 400\">MedRxiv<\/span><\/i><span style=\"font-weight: 400\"> 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Wall EC, Wu M, Harvey R, et al. Neutralising antibody activity against SARS-CoV-2 VOCs B.1.617.2 and B.1.351 by BNT162b2 vaccination. <\/span><i><span style=\"font-weight: 400\">Lancet<\/span><\/i><span style=\"font-weight: 400\"> 2021.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Gov.uk. Coronavirus (COVID-19) in the UK: Healthcare in the North West.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400\">.<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>On the 17 May 2021, the UK government removed the requirement for face coverings in secondary schools in England. [1] Writing in The BMJ on 14 May 2021, we argued [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/11\/covid-19-and-the-delta-variant-we-need-an-urgent-focus-on-mitigations-in-schools\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":50428,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-50423","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"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 the delta variant\u2014we need an urgent focus on mitigations in schools\u00a0 - 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\/06\/11\/covid-19-and-the-delta-variant-we-need-an-urgent-focus-on-mitigations-in-schools\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Covid-19 and the delta variant\u2014we need an urgent focus on mitigations in schools\u00a0 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"On the 17 May 2021, the UK government removed the requirement for face coverings in secondary schools in England. 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