A Safe Return to Schools? What does the Public Health England survey really show?

With the new term rapidly approaching in England, a phoney debate is being created suggesting that school safety campaigners don’t recognise the importance of children being in school. That’s not a debate. The real issue, however, is how that can be done safely.

Parents and school staff are being bombarded with an official narrative that schools will be safe to open with all children present in September. However, those claims are being based on questionable evidence.

Having read the actual content of the latest much-publicised schools survey from Public Health England I would go further and suggest that their claims are actually contradicted by their own facts. 

In my view, the PHE Report actually shows that:

• Any conclusions reached from the PHE survey can only be based on the environment in school settings at that time – i.e. small class and bubble sizes and with most pupils still learning from home.
• The survey only concludes that school transmission risks can be low when class sizes and local infection rates are low too. The data presented suggests that there could be significantly higher numbers of outbreaks if schools reopen without these conditions being in place.
• The Report’s authors make clear its findings should not be applied to secondary schools and accepts that the risk of transmission is higher amongst older children.
• In the thirty identified outbreaks, viral transmission IS clearly recorded as taking place within these (largely Primary and Early Years) educational settings.
• While the survey suggests transmission from staff is more likely than transmission from children, in over a quarter of outbreaks (8/30), children are identified as being the source of the infection within the school.
• The survey results confirm parent and staff concerns that staff can transmit the virus to pupils - and then back to their families – but also shows that staff can also be infected, even by young children, too.
• The Report concludes that “most children were asymptomatic and only identified as part of contact tracing after their parent developed COVID-19, highlighting the importance of access to rapid testing, reporting and contact tracing for individuals to protect the wider community”.
• The Report notes that 90% of schools closed the entire bubble when there was a single case reported and that 43% closed the entire school when there was an outbreak of more than one confirmed case.

Public Health England’s Report – a survey from educational settings in June & July 2020

It’s worth pointing out that the PHE Report, SARS-CoV-2 infection and transmission in educational settings: cross-sectional analysis of clusters and outbreaks in England, does not include medical research about the mechanisms of viral transmission. It is simply a survey of the infections and outbreaks reported in school settings in England in June and July 2020.

However, as the full Report notes, school settings were operating far from normally at that time: “Re-opening of educational settings was partial (nursery, reception, year 1 and year 6 in primary schools, and years 10 and 12 in secondary schools), not mandatory and the decision to re-open schools was met with mixed responses from educational staff and parents. Consequently, not all schools re-opened and not all parents sent eligible children to school during the remainder of summer term (June to mid-July 2020)”

The Report itself acknowledges “important limitations when considering the generalisability of our findings. Educational settings opened after national lockdown when SARS-CoV-2 incidence was low and only in regions with low community transmission. Settings that opened had stringent social distancing and infection control measures in please and, in addition to school attendance not being mandatory, there were strict protocols for class and bubble sizes, which may not be achievable when schools opening fully in the next academic year (and indeed, updated schools guidance now recognises that bubble size may need to be increased from September to ensure that a full range of activities is feasible). Only 1.6 million of the 8.9 million students nationally attended any educational setting during the summer mini-term”.

• Any conclusions reached from the PHE survey can only be based on the environment in school settings at that time – i.e. small class and bubble sizes and with most pupils still learning from home.

Are the chances of transmission in primary schools low? Our survey says: That depends! … on keeping class sizes and ‘bubbles’ small and taking particular care where local infection rates are high 

The PHE survey is being reported as evidence that the risk of viral transmission is low – as only thirty outbreaks were recorded in June and July 2020. However, as stated above, that was based on the environment in school settings at that time – i.e. small class and bubble sizes and with most pupils still learning from home. That’s exactly what ISN’T being planned for September.

The risks of transmission, as has been indicated by reports of outbreaks in schools globally, will inevitably increase if classes reopen at their full size, secondary schools operate bubble sizes of whole year groups and all pupils are on the school site at once – as the DfE intends to be the case as things stand.

This will be true in all schools but particularly the case in areas where there are higher infection rates. As the Report uncontroversially notes “we found a strong correlation between community SARS-CoV-2 incidence and COVID-19 outbreaks in educational settings. This is not surprising since increased community transmission provides more opportunities for virus introduction into educational settings”.

The data provided in the Report’s additional tables illustrates that correlation – but raises an obvious concern as to what the rate of outbreak might be in areas where the case incidence is higher (and there are many such towns and cities already) and without the ability to socially distance through smaller classes:

Fig. 3 from: https://www.gov.uk/government/publications/sars-cov-2-infection-and-transmission-in-educational-settings

• The survey only concludes that school transmission risks can be low when class sizes and local infection rates are low too. The data presented suggests that there could be significantly higher numbers of outbreaks if schools reopen without these conditions being in place.

What about secondary schools where medical research suggests that students may transmit the virus similarly to adults? Our survey says: Nothing, most secondary schools were only open to a few students

The Report is straightforwardly honest about drawing conclusions from its data about secondary schools: “Very few secondary schools opened (and those that did, did so with small class sizes) during the summer mini-term and our results, therefore, are not likely to be generalisable to secondary schools, especially since the risk of infection, disease and transmission is likely to be higher in older than younger children”.

• The Report’s authors make clear its findings should not be applied to secondary schools and accepts that the risk of transmission is higher amongst older children.

Educational settings don’t spread the virus? Our survey says: Yes, they do! 

The survey notes that conclusions about transmission in settings where there were just single confirmed cases cannot be made because “the source of infection was not systematically collected”. But it confirms that there were thirty ‘outbreaks’ (defined as “2 or more epidemiologically linked cases, where sequential cases were diagnosed within a 14-day period”).

18 of these 30 recorded outbreaks were in Primary Schools, 7 in Early Years and 3 in SEND schools. Just 2 were recorded in secondary schools but, as stated above, most secondary classes were not in school at this time.

· In the thirty identified outbreaks, viral transmission IS clearly recorded as taking place within these (largely Primary and Early Years) educational settings.

Children don’t transmit the virus? Our survey says: Yes, they do! 

As is to be expected given global research about transmission from the youngest children, the survey found that “staff had higher rates of individual SARS-CoV-2 infection and outbreaks than students, albeit with wide confidence intervals”. However, politicians and journalists have chosen to focus on just one particular sentence in the Report that suggested that “staff members need to be more vigilant for exposure outside the school setting to protect themselves, their families and the educational setting”.

Many staff would, of course, contend that they are already being highly vigilant but that they cannot be held to blame for the failure by Government to reduce the risks of infection, both inside and outside schools. However, the Report clearly records that it isn’t only adults that can transmit the virus in school settings.

The survey states that “the probable transmission direction for the 30 confirmed outbreaks was: staff-to-staff (n=15), staff-to-student (n=7), student-to-staff (n=6) and student-to-student (n=2)”.

• While the survey suggests transmission from staff is more likely than transmission from children, in over a quarter of outbreaks (8/30), children are identified as being the source of the infection within the school.

Staff can only transmit the virus to other staff? Our survey says: No, that's not the case! 

Again, the Report in full records that “of the 30 student cases involved in an outbreak, the potential source of infection in 27 children included a household contact (n=8), a school staff member (n=17) and another student (n=2).”

And, “of 91 staff members involved in an outbreak, where a potential source of infection could be identified, 9 acquired the infection from a household contact and were the likely index case in the outbreak and 52 likely acquired the infection in the educational setting from another staff member (n=46) or another child (n=6)”.

• The survey results confirm parent and staff concerns that staff can transmit the virus to pupils - and then back to their families – but also shows that staff can also be infected, even by young children, too.

Did testing and tracing help identify infectious children? Our survey says: Yes.

Schools are being instructed to return to full opening while there are still considerable questions over the reliability off the test-and-trace systems in place, let alone making provision for the regular onsite testing of staff, so as to screen them for possible infection.

Confirming the evidence of child transmission, the report states that “Seven primary school outbreaks involved staff and students. In this small sample of outbreaks the student was most likely the index case in 6 outbreaks” but also adds that “In 5 outbreaks, the child (index case) was identified through ‘test and trace’; i.e. testing of the whole household when parents (healthcare workers in 3 cases) had tested positive for SARS-CoV-2. Seven staff members in contact with the index cases (3 tested because they became symptomatic) subsequently tested positive for SARS-CoV-2”.

• The Report concludes that “most children were asymptomatic and only identified as part of contact tracing after their parent developed COVID-19, highlighting the importance of access to rapid testing, reporting and contact tracing for individuals to protect the wider community”.

Did schools close whole bubbles if there was just one case? - Our survey says: Yes, most have done so, some have closed whole schools. 

The Report notes that where there were only single confirmed cases, “Among 43/48 (90%) cases with available information, the case and contact bubble were excluded from 39 educational settings while four educational settings decided to close entirely because of a perceived risk of onward transmission, although this was contrary to national recommendations. For the remaining five cases (3 staff, 2 children) only the confirmed cases were isolated because they had remained outside the educational setting throughout their infectious period ”. 

In the 30 schools with outbreaks of more than one confirmed case “affected contact bubbles were excluded from school in all 30 outbreaks and 13 also decided to close either on an interim basis (to allow for deep cleaning or for exclusion periods to elapse) or for the rest of the term”.

• The Report notes that 90% of schools closed the entire bubble when there was a single case reported and that 43% closed the entire school when there was an outbreak of more than one confirmed case.

Martin Powell-Davies, August 25 2020

Tories forced into Exam grade U-turn - LBC debate

After the Tories were forced by mounting youth protests into a U-turn over exam grading, I was invited to debate alongside Katharine Birbalsingh on LBC radio this morning. 

Here's what I had to say: 

 

From first wave to second? Boris Johnson’s covid failures

Back in March, when the spread of the coronavirus pandemic was accelerating globally, the Socialist newspaper explained that “a newly-spreading virus is a danger that can befall any society. The question facing the world today, however, is what kind of society can best meet such a challenge.”

Five months on, just as we warned, the inability of global capitalism to respond to such a crisis has been sharply exposed. Its failure to protect both lives and living standards will have a lasting effect on workers’ consciousness and influence the struggles that are to come.

According to official statistics, over 700,000 people have died worldwide as a result of Covid-19, although the real figure could be much higher. Workers’ trust in the ability of their governments to even count death tolls accurately has been another casualty in the crisis.

Globally, the pandemic is still accelerating. It is now taking a heavy toll in the neocolonial world, where capitalism’s ongoing failure to provide health facilities, housing, food, and incomes now leaves millions highly vulnerable to the virus.

But capitalism’s failures are also graphically exposed by the fact that the three countries with the highest official death totals at the end of July – the US, Brazil, and the UK – should all have had the economic resources to deal with the crisis. Instead, many thousands have died needlessly thanks to the inept leadership provided by the right-wing Trump, Bolsonaro, and Johnson.

Short-sighted

Instead of following the advice of medical experts to urgently introduce widespread testing and contact tracing alongside measures to prevent transmission, these representatives of the most short-sighted capitalists resisted taking steps that might threaten profit-making.

In doing so, they have ended up making matters worse even for their own wealthy backers. Their delay has only worsened the damage that has been done to the already-vulnerable global economy.

While countries like China that still retain elements of state ownership were better able to direct resources in a planned manner, a privatised economy like Britain’s was unable to respond quickly enough.

It immediately became clear that there was a critical shortage of PPE for health and care workers. But Public Health England’s solution to the problem was to fit its advice to the availability of equipment, revising its guidance downwards, advising that less-stringent protection was required.

Years of health cuts had left the NHS without the capacity to carry out mass testing. At first, the Tories ignored this vital need.

A catastrophic consequence was the discharge of thousands of elderly patients into care homes without any prior testing for Covid-19. Over 19,000 Covid-19 related deaths have since been registered for care home residents in England alone.

Ministers then decided to open their coffers – but not to fund NHS laboratories. No; instead contracts were awarded to private companies like AstraZeneca and GlaxoSmithKline, even though both had no proven track record in diagnostic testing.

Instead of a medical professional, the Tories decided to put one of their own – the Conservative peer and previous CEO of TalkTalk, Dido Harding – in charge of the test-and-trace programme. As a board member of the Jockey Club that had been so keen on the Cheltenham Festival going ahead at the end of March, she was clearly well-qualified in viral spread!

But under Harding’s ‘leadership’, the promised NHS contact-tracing phone app has had to be scrapped. There is still no date for an alternative.

Now the Lancet Child and Adolescent Health have warned that the current NHS testing and tracing programme is too ineffective to prevent a second wave if schools reopen full-time in September. The study estimates that too few infectious individuals are being detected by testing and too few of their contacts are then being traced and isolated.

Moreover, the government had pledged to test all care home residents and staff by July – now that has been postponed to September. Yet another failure to deliver.

As well as the elderly and more clinically vulnerable, those working on throughout ‘lockdown’ without sufficient protection have been left at risk. Official figures for England and Wales listing the occupations where most deaths have occurred include not only nurses and care workers, but also security guards, factory and construction workers, taxi and bus drivers, chefs, and sales assistants.

Shielding is now ending – at the worst possible time. As a possible second wave gathers, there must be no compulsion to return to the workplace, or ending of support, for those most at risk.

The recent outbreaks – first in Leicester and Luton, then much of the northwest of England – expose how the lack of a working test-and-trace system is costing further lives. In response, the British Medical Journal has demanded testing and tracing be integrated back into NHS and local authority control.

Private v planned

In short, privatisation is costing lives. Tackling the virus requires democratic control and planning – and hence public ownership.

If that’s true on a local scale, it’s even more the case on a global scale – particularly in the urgent work needed to try to develop vaccines against Covid-19. Under capitalism, the profit to be made from developing a viable vaccine before your competitors prevent the global sharing of research that would guarantee its quickest development.

In the absence of a vaccine, the pandemic remains an ongoing threat. But the likes of Johnson hoped they could get away with opening up the economy without a serious strategy to control the virus.

More serious establishment scientists, like those in ‘Independent Sage’ that split from the official government Sage group in May, warned that what they describe as a “fingers crossed through reopening” strategy was unlikely to be good enough.

The controversy over quarantining holidaymakers returning from Spain revealed the growing concern that, as lockdown measures ease, cases would again start to rise. That’s certainly the case in countries like Israel, Japan, and Australia. Now case numbers seem to be rising in Britain too.

Workers and their trade unions have to sound the alarm – and refuse to buckle under the pressure from big business to rush into an unsafe opening of workplaces, shops, and schools. Instead of short-sighted capitalist profiteering, socialists demand a serious strategy to eliminate the virus. That needs to include:

• A fully resourced, community-based testing and tracing system – run through the public sector, not private profiteers
• Protection, support and full income for all those at greatest risk, needing to isolate, or hit by the economic crisis
• Democratic trade union and workers’ control over workplace safety

This article was written for the Socialist newspaper and also posted on the website of the CWI on: https://www.socialistworld.net/2020/08/05/from-first-wave-to-second-boris-johnsons-covid-failures/?

The scientific evidence mounts: children DO transmit Covid-19

As the school year came to an end, official opinion was increasingly of the view that schools would be able to open fully again in September with only very limited safety measures in place. We were told that case numbers would continue to fall over the holidays and that, in any case, it seemed likely that schools and schoolchildren didn’t play much of a role in virus transmission. Those of us who warned this might be mistaken would have loved to have been proved wrong. Unfortunately, as each day passes, it seems official opinion has, sadly, been over-optimistic.

The controversy over quarantine on returning from European holidays has revealed the concern that remains across Europe about infection rates increasing once lockdown measures are relaxed. That’s also a pattern that’s revealing itself globally, notably in Israel, Australia and Japan. There are now also the first signs that case numbers are starting to rise again in the UK too.

Yet, when SAGE, the official scientific advisory group to the UK Government, released its latest analysis about reopening schools on 24 July, in their view, “given the low risk of transmission between children”, there was no need to recommend facemask use and no suggestion that the previous limits on class sizes, to enable greater physical distancing, needed to be maintained.

A closer look at SAGE’s appendices, however, shows only a limited research basis on which to draw such a significant conclusion. They pointed to a Dutch contact tracing analysis that suggested most adults were infected by other adults, not children. However, other Dutch epidemiologists had already criticised their methodology. SAGE also pointed to a study of a school in a Paris suburb that a found no evidence of onward transmission from children. However, they failed to mention another study in the same area that concluded that high school children COULD transmit the virus.

Yet one of the contact tracing studies cited in ‘Annex A’  – but not referred to in SAGE’s full Report – should have already started to set doubts in SAGE’s minds (if, of course, these were objective minds and not ones trying to find evidence to back up the Government’s economic imperative to make sure schools were fully open to provide full-time child-care). This is an Israeli study from June 2020 taken across over 600 households that showed that, yes, children had a lower relative infectivity than adults but not at any significantly lower level – perhaps 85%.

In the last few weeks, the global research basis has been growing – and the evidence that children, and schools, contribute to viral transmission is growing rapidly. For example:

• A study from South Korea, shows household transmission was highest of all age groups for those aged 10-19
• Research from Germany continues to show that there is little difference in “viral load” between children and adults.
• In Israel, where infection rates have been rising sharply since lockdown measures were relaxed, a report on a recent outbreak shows widespread transmission took place within the school. The highest infection rates were amongst 13-15 year old students.
• In Victoria, Australia, where infection rates are also now rising, an outbreak in a school was linked to substantial transmission amongst senior students after they returned to face-to-face learning
• Another contact tracing study from Trento, Italy, has reported transmission from children to adults with children in the 0-14 age group showing the greatest infectivity.
• A study from the United States has indicated a correlation between how quickly different states closed their schools and the rate at which mortality rates then fell
• A report on a recent outbreak at a children’s camp in Georgia, USA, where there appears to have been widespread transmission amongst attendees. Of those tested, 51 out of 100 6-10 year olds tested positive and 180 of the 409 11-17 year olds (see table below).
• A study from Chicago, USA finding that children younger than 5 with mild to moderate COVID-19 have higher amounts of SARS-CoV-2 viral RNA in their nasopharynx than older children and adults

Of course, the science is still developing and research and reports are open to debate and review. But, the weight of evidence is now mounting up. Given the health risks of infection, surely advice should at least be based on the “precautionary principle” that minimises risks as much as possible? That’s exactly the approach recommended by the Harvard T.H. Chan School of Public Health in its advice on reopening schools in the US.

The advice from Harvard is in sharp contrast to the inadequate guidance issued by the DfE in the UK. They conclude that “It is reasonable and prudent to assume that COVID-19 transmission may occur between children and from children to adults in reopened US schools”. They recommend that students wear face masks and that staff wear masks for close work and face shields when at front of class. They also  make other recommendations that echo those of the NEU’s “5 tests” including the reduction of class sizes in order to maintain physical distancing, stressing the importance of diagnostic viral testing and official advice on closure, cleaning and contact tracing if there is a case in a school.

The Harvard advice also calls for authorities to “provide necessary supplies and support systems to continue remote education for students staying home” and to “advocate for high-risk students and staff to have access to effective remote learning or work”.

Of course the situation in the UK is not exactly identical to the US, but the risks from the virus are the same across the globe.

What all of this research confirms is that the DfE guidance – recommending that schools open with full classes, no effective physical distancing and no PPE – is looking increasingly reckless. Trade unions and parents must urgently demand that advice is withdrawn and replaced with a strategy that recognises – and properly mitigates against –  the real risks that schools could spread infection within school communities.