Are schools safe? England’s plan is a giant natural experiment

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After two months of lockdown, Matt Dix is anxious about his return to work. The primary school teacher will have to get creative to keep his Year Six students at a distance from each other when his Nottinghamshire school reopens next month, while making sure those still at home also receive their learning materials. But Dix is also concerned about the health of his students and his family. “The fear is that we are being used as guinea pigs to see if the [reproduction number] goes up,” says Dix. “For the sake of four weeks, what is going to be the impact on children?”

With primary schools students in England set to return gradually from June 1, scientists are still trying to figure out how big an impact reopening schools will have on the England’s coronavirus outbreak. Children make up a small proportion of confirmed cases and, when they become ill, they tend to have mild symptoms, if any. How children influence the reproduction number for Covid-19 – meaning the average number of people that one infected person will pass the virus on to – remains a critical scientific question. Scientists will only receive an answer once children start interacting again with their classmates and teachers.

France, Germany, the Netherlands and England are the latest nations to let children return to school. The approaches and timetables differ widely across the continent, which essentially turns classrooms into a giant “natural” experiment to find out what works and what doesn’t. Since May 4, German pupils who are about to transition from primary to secondary school and students who are expected to take exams are allowed back in classrooms. To reduce the risk of transmission, class sizes have been cut in half and lunch breaks are staggered. Denmark, the first country in Europe to reopen schools in mid-April, has prioritised nurseries and primary schools, arguing that small children are least at risk of infection and are less able to learn by themselves. Social distancing now means teachers and students are wearing masks, and desks have to be spaced at least two metres apart.

Early data from Denmark looks promising. The reopening of schools doesn’t seem to have caused a new wave of infections. As of May 15, one month after children returned to the classroom, the country’s number of new infections is still dropping. While it is too early to tell how the easing of lockdown restrictions will play out in the rest of Europe, many countries are placing schools at the centre of plans to kickstart their floundering economies. As soon as schools reopen, many parents will be able to return to work.

In a nationally televised evening speech on Sunday May 10, prime minister Boris Johnson announced that schools in England may reopen as early as June 1, in stages, beginning with reception, Year One and Year Six. The reasoning behind the move was “to ensure that the youngest children, and those preparing for the transition to secondary school, have maximum time with their teachers” before the summer break, as laid out in a 50-page guidance document published the following day.

Class sizes will have to be split in half to no more than 15 pupils and there should be a “one way” system in corridors. Dix teaches a class of 30 in a Victorian school building with narrow corridors and small classrooms, where six to nine pupils could be taught at a time with social distancing measures. Children doing school work from home would still be able to interact with their teacher and other pupils online, but they may have less interaction during the day when lessons take place. “The only thing that will work is completely school dependent. There are no two schools that are the same,” says Dix. “You can’t have a one-size-fits-all approach that the government is trying to give out that will work for a school, head teachers, the parents and the community that are working together to decide what fits best for their individual circumstances.”

The envisaged timeframe will depend on the England’s ability to consistently keep its reproduction number below one. In order to understand how the reopening of schools might impact the reproduction number, which at the time of writing is thought to hover around 0.7, epidemiologists first have to look at how effective school closures were at reducing the viral spread.

New evidence from China might give a clue. The authors of a study published on April 29 in the journal Science analysed data from Wuhan, where the virus first emerged, and Shanghai. Although school closures were not enough on their own to stop virus transmission, they lowered the reproduction number by about 0.3. An epidemic starts to grow exponentially once the reproduction number is above one, so for countries that are close to the threshold, an addition of 0.3 could have a devastating effect.

To come to this conclusion, the researchers asked 636 study participants in Wuhan and 557 participants in Shanghai to recall who they had come in contact with on a regular day during and before the outbreak – contact was defined as either a two-way conversation in person or a direct physical contact such as a handshake.

The team also had access to contact tracing information from Hunan province’s Centre for Disease Control and Prevention, which traced 7,375 contacts of 136 confirmed cases. All close contacts were placed under medical observation for 14 days and tested for coronavirus. The dataset also captured people who became infected but remained asymptomatic, providing a clearer picture of the susceptibility between different age groups. Children (aged between zero and 14) appeared to be about a third as susceptible to coronavirus infection as adults.

Marco Ajelli, a mathematical epidemiologist at Indiana University School of Public Health who carried out the analysis while at the Bruno Kessler Foundation in Italy, says this allowed the team to calculate the impact of public health interventions on viral transmission. In short: When schools were open, children had three to four times as many contacts as adults, which would essentially have cancelled out their lower risk of infection.

Ajelli points out that there is one critical question that the study doesn’t answer: Are children with Covid-19 less infectious than adults? “The infectiousness of children hasn’t been measured in a direct way so far. We don’t have evidence in one direction nor the other. It is possible that it is lower and it is possible that it is the same [as adults],” he says, adding that his team assumed the infectiousness was the same between children and adults due to the lack of evidence proving the hypothesis wrong.

Another group of researchers analysed the viral loads of children that were routinely tested for coronavirus at the Institute of Virology at Charité Hospital in Berlin and posted their preliminary findings online on April 30. Even though children experienced milder symptoms of disease, those infected appeared to harbour just as much virus in their body as adults. “Based on these results, we have to caution against an unlimited reopening of schools and kindergartens in the present situation. Children may be as infectious as adults,” the report said. However, it is not yet clear whether viral load is an indicator of how infectious a person is.

Children may indeed shed as much virus as other age groups, but it is too early to draw any conclusions, according to Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene and Tropical Medicine. “Further research is required to understand other factors involved in viral spread, for example coughing, as children without symptoms may cough less and transmit less through this mechanism. Ideally this would take the form of actual transmission studies based on contact tracing,” he said in a statement to the Science Media Centre.

In late April, the UK Department of Health and Social Care started sending out nose and throat swab tests to households in England – children, however, are only eligible for a test if they show symptoms. In the US, the National Institutes of Health will be following 2,000 families over the next six months to determine whether healthy children and children with asthma become infected with Sars-Cov-2 and, if so, whether they pass the virus on to other family members.

While scientists are still grappling to understand the role of children in the spread of coronavirus, schools are starting to open up. Some may argue that the benefits of opening schools outweigh the risks. Children can see their friends again and those who have struggled with distance learning will feel more supported. They can also better prepare for the transition to secondary school. Parents can get back to work, or free up time to be more efficient working at home.

While there are some advantages to bringing children back to school for a month before the long summer break, it can also disrupt their new routines. “I think it’s a very strange choice to have the youngest children going back first,” says Emma Maynard, a psychologist and senior lecturer in education at University of Portsmouth. Pupils in reception and year one only recently started formal education and will have had to resettle for half a term, which can be disruptive for young children. They will also find it difficult to adhere to social distancing measures, she says. “They need a lot of tactile involvement, they’re very busy and move around all the time. That’s very good for children because that’s how they learn.”

Students in Year Six may find it easier to follow social distancing rules than their younger peers, but some might still struggle in the new environment and feel isolated from their peers. “Schools are a phenomenal force in children’s lives,” says Maynard. “Schools offer them routine, structure, familiarity and the positivity of learning. But I don’t think that’s why children are being sent back to school, I think that’s about the economy and childcare. The problem is that might well be at cost to teachers.”

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