COVID-19: Statement on schools reopening

By Dr Peter English, Chair, Public Health Medicine Committee, British Medical Association.
Location: UK
Published: Wednesday 20 May 2020

“Balancing health risks with the educational needs and wellbeing of children during a global pandemic is not an easy or simple feat. The sole focus of the BMA in this regard is the protection of children, their families, school staff and the population at large during what is the greatest public health threat in a generation.

The decision about when schools should be allowed to reopen is an extremely difficult one. We know that the longer children are kept away from the classroom, the greater the harm to their education, to their life opportunities and indeed their mental, physical and social wellbeing. For disadvantaged children, this harm is sadly even greater.

A focus on arbitrary dates for schools to reopen fully is polarising. The BMA wants schools to reopen as soon as it is safe to do so and the evidence allows – this could be before June 1st or after. A zero-risk approach is not possible. This is about ‘safe’ being an acceptable level of risk.

Parents up and down the UK are asking the same question: is it safe? The simple answer is, we do not yet know. Our neighbours in Scotland, Wales and Northern Ireland have adopted a more cautious approach, not yet opening schools until more evidence is available.

There is growing evidence that the risk to individual children from Covid-19 is extremely small. However, there is no united view yet from the scientific community on how likely it is that children can spread this deadly virus to others, including vulnerable adults. In April, a study by University College London (UCL), London School of Hygiene and Tropical Medicine, Cambridge University and Sydney University using data from previous flu outbreaks, suggested that school closures “could have relatively small effects on a virus with COVID-19’s high transmissibility and apparent low clinical effect on school children”.

When exploring how infected children can transmit the infection, investigators at the Institute of Virology at the Charité Hospital in Berlin concluded “Based on the absence of any statistical evidence for a different viral load profile in children found in the present study, we have to caution against an unlimited re-opening of schools and kindergartens in the present situation, with a widely susceptible population and the necessity to keep transmission rates low via non-pharmaceutical interventions. Children may be as infectious as adults.”

Equally one of the first reports on the epidemiology of the virus to come out of China suggested that children were just as likely to be infected as adults. This was at the time the R0 value in the region had been reduced to 0.4 by social distancing and contact tracing and is therefore similar to the current situation in London.

Further, a recent survey from scientists in Wuhan, published in the journal Science, concluded that although school closures were not enough on their own to stop virus transmission, they lowered the ‘R’ number, or reproduction number by about 0.3, and this could contribute to preventing an exponential rise.

The Committee I lead, the Public Health Medicine Committee, is clear that the available evidence is conflicting, and we need to know more on the infectivity of children.

This is changing daily. In the coming weeks we will have much more data, as many other countries who are ahead of the UK in the course of this pandemic are now beginning to reopen their schools. This data could be vital to the decision-making process. The early signs from 22 European nations who announced yesterday appears, on the face of it, promising. And yet we have seen that in just a week after one-third of French schoolchildren went back to school in an easing of the coronavirus lockdown, there was a flurry of about 70 Covid-19 cases linked to schools

The Government’s decision on whether to reopen schools is a finely balanced and unenviable one. Our passion and the focus of my committee is the eradication of health inequality. As the ONS has found, this virus disproportionately affects those from the most deprived background as well as some BAME communities. We must safeguard against any measures that risks exacerbating those inequalities. A second peak would impact the disadvantaged the most and could lead to schools being closed for a far longer period.

We will continue to review the data and offer our full-hearted, academic support to families, school staff and the government as they work together to allow schools to reopen safely. This is a common endeavour.”