Lessons not learned: The disaster of Covid-19 school closures

Part 3 of the pandemic review looks at how the UK handled one of the most controversial interventions of the pandemic

One thing I know from working in child health is that issues affecting children quickly become emotionally charged. People care deeply about the welfare of their children, and when disagreements emerge it doesn’t take much for things to get heated. The discussion over school closures during the pandemic has been a prime example, and this has often been to the detriment of constructive discourse.

Here we will try to disentangle the UK’s management of school closures.

Contagious closure

Much has been made of planning based on pandemic influenza and it’s influence on Covid-19 policy. This is particularly true of school closures as a non-pharmaceutical intervention, as it has long been considered a reasonable measure in the short term to help curb transmission (although it has it’s own controversies). This is because children are recognised to play an important role in the transmission of flu. They are more susceptible to infection and spread the virus more easily, including between households.

Alongside this history, there was a lot of initial uncertainty around the role of children in the transmission of Covid-19, and over how severely children might be affected by disease. Suddenly, in March 2020 countries all around Europe and elsewhere in the world began closing schools almost contagiously.

Given this uncertainty, temporary school closures were arguably forgivable in the first instance.

What followed however, is a different story.

Priorities

It became apparent surprisingly quickly that children had not played a key role in the initial transmission of the SARS-CoV-2 virus, and were not superspreaders in the way they are thought to be with influenza. By the spring of 2020 many European countries had prioritised the reopening of schools, and none of them experienced an early resurgence in cases of Covid-19 nor a rise severe illness.

Sweden suppressed it’s first wave in a similar manner to the UK without ever closing schools for children aged <16 years.

Denmark quickly reopened schools for primary aged children, cutting class sizes down, appropriating unused public spaces and gathering university students to act as class teachers.

Norway prepared to reopen schools within 2 weeks of enacting closures, and their recent official pandemic review still concluded that measures taken were disproportionately harmful to children.

Despite offering positive intentions, the UK failed to get all but 2 year groups of children back to school at this time. This was predominantly off the back of pressure from unions over risks to both children and teaching staff. This is despite the overwhelming body of evidence during this period being highly reassuring on both fronts.

It is a stain on our early pandemic response that during the spring and summer of 2020, pubs and restaurants were open whilst schools were closed.

The best that can be said of the UK attitude towards schools was that from this point onward, it could have been worse. Many countries elsewhere in Europe, and particularly in north America shamefully neglected children’s rights to access education, and the other essential health and social benefits afforded by in person schooling.

Thanks to intense advocacy from the children’s commissioner and the Royal College of Paediatrics and Child Health, the UK government finally instituted a, “last to close, first to open” policy for schools after the first lockdown. Since then, it has rightly focussed more on mitigations for adults rather than younger children.

Mitigation

Whilst not alone, the UK did take an unimaginative approach to infection mitigation within schools, which was important primarily for reducing school absenteeism. Early and robust investment in upgrading ventilation systems would have paid off in the longer term as well as bringing short term benefits. Reducing class density by appropriating unused buildings and inviting volunteers to provide additional staffing in a “nightingale schools” effort was never on the cards. The use of facemasks remains controversial, and however they were implemented large numbers of people would be left unhappy. Sadly, we have no high quality evidence to guide precisely how effective they are in this setting.

Unfortunately, the most effective methods of preventing infection (isolation and quarantine, bubbles) are also the most disruptive, and “test to stay” strategies came quite late (although the UK must take credit for one of the only randomised trials of a non-pharmaceutical intervention during the entire pandemic, of daily rapid testing in place of quarantine for schools).

Harms

There is no question that prolonged school closures are one of, if not the single most harmful non-pharmaceutical intervention at a population level. Evidence is mounting of exacerbation of inequalities in educational attainment, devastating harms from lack of access to safeguarding procedures, mental health crises from social isolation, increased obesity, and the list goes on.

It is likely the long term morbidity and mortality of these harms to children will exceed that inflicted by the virus if sufficient efforts are not made to prevent it. Sadly, the current plans to redress these harms in the UK are anaemic and half hearted.

Despite prioritisation of other societal activities over schools being justified by needing to boost the economy, these short term gains are likely dwarfed by the long term economic harms from the dent in children’s education, estimated to run into hundreds of billions of pounds in the UK alone.

Summary

We knew early on that children were not the primary drivers of transmission and were extremely low risk from disease, and therefore schools should have been prioritised. Opening schools with any circulating Covid-19 will of course lead to some level of increased transmission, however this was significantly less than would otherwise have been expected from a respiratory virus. Ultimately, the harms associated with closures exceed those which occur as the result of increased transmission.

Whilst the harms of closed workplaces can be financially remunerated by the government (e.g. through the furlough scheme), there is no way of paying off the harms of loss of education, and the health and social benefits of attending school in person.

Worse, these changes disproportionately affected the most disadvantaged children, whose families are least able to afford the time or money needed to recover these losses.

We should have recognised this early and made schools an absolute priority. Instead, we had pubs open whilst schools were still closed. It was a blight on our early pandemic response. There were no “Nightingale” schools.

The fact that many other countries prioritised children even less than the UK is poor solace.

It is vital that schools are considered essential infrastructure for any future pandemic planning.

This was part 3 of the UK pandemic review mini series. For the introduction and to read other parts of this series, you can click here.