I cannot fulfil duty to ensure the school is "as safe as reasonably practicable"
[This post has been edited since the original publication to remove references to the particular school and the Principal as the main problem is the government guidance which is being followed].
I have resigned as a parent governor and as a director of the trust of the secondary school because government guidance has made it impossible to fulfil my duty as a governor and under Health and Safety legislation to ensure that the school is safe for students from COVID-19. I will not be complicit in the government's plans that will inevitably lead to a massive scale of infections and a great deal of harm on a national level.
The current guidelines and policies may have been appropriate if the cases were at very low levels but that is not the current situation either locally or nationally with case rates higher in the 10-19 age range than at any point before this summer in Surrey Heath. Given how fortunate we have been in Surrey Heath to have low cases until this point (about 11% of 10-19 children in Surrey Heath have had confirmed cases of COVID at any point) we are actually more vulnerable now as there will be little natural immunity amongst school children.
I want to be clear that the school is fully sticking to the government guidance, going further in some places and the Head has expressed his willingness to go respond effectively in the event of outbreaks which I welcome. I have no reason to believe that any other local schools are in a substantially better position. Most of the information in this document has been conveyed to the Head in slightly different form, there may be some minor data updates or new different links to research that have not been shared if I didn't think that they were significantly persuasive.
I very much hope that I'm wrong as to the level of increase and the likely serious harms and I keep looking for evidence that it is safer than I think and not finding it or where it exists there are clear flaws in the information (e.g. studies on the safety of schools substantially covering periods when they are closed).
The exact timing is triggered by the failure of the government to announce a roll out of the vaccine programme to 12-15 year olds and local case rates continuing to rise for the 10-19 age range.
Below I set out:
- Why I don't believe it is safe for children and teenagers to get Covid.
- The current high rates and therefore risk level especially locally in Surrey Heath.
- The protections that should be in place (mostly government action required and those that could be done locally would mean ignoring government guidelines).
It is not safe for children to get COVID-19
Children are at lower risk than unvaccinated adults but that doesn't mean the risk itself is low and it should be assessed in absolute terms rather than relative to other groups. It is a preventable disease (see New Zealand) and actions can be taken to remove most of that risk. The government messaging seems to be that it doesn't matter if children catch covid and they will only take stronger action if the NHS viability is threatened but there is real harm and risks that they are glossing over, especially with the Delta variant (now absolutely dominant in the UK). In the US many states ICUs for children are full and there are real problems, especially where masks were discouraged.
Deaths
During 2021 so far (unto week 34) at least 68 10-19 year olds have died from Covid in England and Wales (source ONS). That isn't thousands like for adults but it is a substantial number of families greatly harmed. 68 is about 1 per 100,000 of population but about 7 per 100,000 confirmed cases in that age range. That isn't massively high but it does mean in a population the size of the school there would be about a 12% chance of a death if almost every student was infected. That is a risk worth mitigating against where possible.
Total deaths including adults in the UK are at well over 100 per day (more than the total from the last 20 years of terrorism in the UK), 3,176 in the month to 4th September (greater than the toll of the 9/11 terrorist attacks). Spread within schools will get back into the community and this rate is rising currently despite the vaccine rollout progression. The vaccine is very effective but it doesn't give complete protection and there are many unvaccinated people remaining particular middle aged and below.
Hospitalisation
Child hospital admissions in the UK over at least one night numbered more than 1,000 in both July and August. Almost all will survive but that is a huge number of children and families suffering very traumatic experiences and there are also likely long term effects from severe Covid cases like this. Based on the infection rates over that period it seems like about 500 hospitalisations per 100,000 cases or if most of the school was infected there might be 8 or 9 hospital admissions resulting. Again a risk very much worth mitigating.
Long covid
Some studies have shown 8-14% of children have symptoms lasting longer than three to four months. This happens not just in the severe case but in many cases that appear mild during the main infection. In some, much smaller number of cases debilitating illness can persist that seems similar to CFS/ME (Chronic Fatigue Syndrome) that can be a lifelong hard to treat and manage condition. The odds of serious cases may be fairly low but I haven't seen anything from government or JCVI really considering these risks and factoring them into assessment of what risks are acceptable. The numbers on this are much more fuzzy and definitions are less clear cut but if much of the schoo was infected there would be potentially be over a hundred students facing long term impacts and it is not unlikely that there might be a number of really severe cases too.
Cognitive impact
A study has shown impact on scores in intelligence type tests with the level of cognitive loss varying by severity of the covid case though even for people with mild cases there was some loss and for severe cases it was approximately equivalent to 7 IQ points which is substantial. Physical impacts on brains have also been observed in both human and animals, some of them being similar to pre-cursors to Parkinson's disease or alzheimer's. It is impossible to know yet how much the chance of getting either of these will be affected but it is not a risk that I would call safe.
Covid hasn't gone away
National case rates are nearly 40,000 a day in the UK at the moment. We are starting the school year with cases over twenty times higher than last year and with a variant that is over twice as infectious as the one that led to the November lockdown last year. In fact cases are already higher than at that point (this summer rates are higher than at any time except the 3 weeks after Christmas). Over 1,000 people are still dying each month at the moment, it has only disappeared from the media.
Especially worrying is the extremely rapid rises in Scotland over the past couple of weeks where schools went back a couple of weeks earlier (with greater protections in terms of masks in secondary schools and required household and contact isolation until a PCR negative test is obtained). I fear Scotland gives an indication of the way that England will be going over the next few weeks.
SAGE predicts exponential growth
On 27th August the SAGE modelling group released a paper written on the 11th August that describes their consensus position on the likely effect of schools returning in September.
The conclusion was this (bold is theirs and "highly likely" means 80-90% probability):
It is highly likely that high prevalence will be seen within schools by the end of September 2021. This may reflect either community or within-school transmission, and the role of schools in driving wider transmission remains uncertain. Regardless of this, it would be sensible for government to plan for this eventuality.
Cases are high in Secondary age children in Surrey Heath
As you can see from this graph on a weekly basis the infections amongst the 10-19 age group are higher than they have been at any point in the pandemic. [Source: CSV data download from government data dashboard.]
Existing immunity is low in Surrey Heath
From the same data source we can calculate the proportion of Surrey Heath's 10-19 year olds who have already been infected is only 10.8% (population numbers in this CSV). That is 1159 recorded cases so far out of 10,706 in that age range in the borough. Even assuming half of cases went undetected or unrecorded in the official numbers that would still only be 20% who have any immunity at all and it appears protection against delta from previous variant infections is limited.
Scotland
The Scottish situation is useful to look at because their schools returned about two weeks earlier and that period has coincided with a massive rise in cases. [Source: Government data dashboard]. Unfortunately I can't find in the data any age breakdown so there may be other explanations than schools although it seems the most likely on.
Measures that should be taken
Not all of these are under the control of individual schools. For many government action is required but several such as masks can be implemented at a school level (although at national level would be even better). It might be sensible to base the level of response such as whether masks are required, recommended or just optional depending on local infection rates.
Vaccination
Vaccination reduces the chance of infection and greatly reduces the chances of serious consequences (hospitalisation, death or long covid).
The case for vaccinating the 12-15 age group is absolutely convincing and as soon as MHRA approval is complete we should probably go younger into the primary ages too. Even the JCVI analysis (which seems to use a deeply flawed approach basing risk on the number deaths only and compare that with the total population rather than the population likely to be infected over the coming months) states that there is greater benefit than risk on an individual basis without even considering the community impact of reducing infection spread and lost time in school while. Most of the developed world including USA, much of Europe and Australia are already vaccinating 12-15 year olds, the UK vaccination program is lagging.
I'd go as far as to say that if secondary pupils had been given the opportunity to be double vaccinated over the summer I would be relatively relaxed about the safety in schools but that has not happened and we don't yet have a timeline. Even vaccinated I would prefer that there were also efforts to bring down cases but they would then be easier and more about community protection and prevention of new variants than the absolute safety of students at the school.
Facemasks
This is the cheap easy intervention which could play a substantial part keeping spread in schools down substantially. If mandatory or otherwise very widely adopted it will prevent a portion infections reducing numbers harmed until the vaccine is fully administered. Masks are mandatory in many parts of the world even in primary schools, the UK has been an outlier all year. However in Scotland, where masks are mandatory in secondary schools it doesn't seem to be containing infections completely right now so alone I don't think it is sufficient as a control mechanism but in combination with other approaches it can play an important part. It may be that it can substantially delay the point at which remote learning is required (given that is a high priority of government the lack of support for masks baffling).
Quality of masks does make a difference too. Any mask is better than none and will greatly reduce the amount of virus released into the air by an infected wearer. To give the wearer good protection from exposure to an infected person FFP2 or FFP3 masks are the gold standard (N95 is I think the US equivalent) and worn well will give nearly 100% protection. Surgical masks have proved not completely effective although good protection can be achieved by double masking with a fabric mask combined with a surgical mask. Multi-layer fabric masks are also better than thinner single layer masks. Valved masks should be avoided as exhaled breath can bypass the filter so if you are infected the chance of spreading is increased.
That my son is able to wear an FFP2 mask when indoors at school is a key part in me having confidence to allow him to attend at least at current infection rates. We are currently using this product (I have no links to supplier or particular recommendation above others). I recognise my privilege in being able to protect my child like this. I did offer a donation so that masks could be provided to students receiving free school meals (or otherwise facing financial hardship) but it was declined as the current guidelines discourage mask wearing and it would go against that. If any students or parents would struggle to afford such masks but would use them please get in touch and I'll arrange something. Everyone should have the opportunity to make their child as safe as possible in the circumstances as I have.
Test Trace Isolate
The lateral flow testing may have a limited effect on slowing spread if it detects cases that can then be isolated but the greater value in my view is for monitoring the rate of cases in the population and assessing how many other cases might be being missed. That they are twice weekly also means that depending on the timing of when the infection develops there may be a couple of days of time to spread the infection before the next test. One of the reasons that COVID is so hard to contain is that in many cases someone is infectious for several days before they get symptoms. Delta is especially bad, one study showed that on the first day an infection was detectable with a PCR test the amount of virus being released was 1,000 times higher than with the original variant.
The removal of household and close contact isolation (except for unvaccinated adults) by the government weakens the effectiveness of testing as a control mechanism because to stop outbreaks there is a need to get ahead of the infection. I have seen no studies or information that biweekly testing without isolation of contacts has stopped spread in any country. The government information campaign to encourage confidence in returning to schools compared with the Olympics. However in that case there was 100% daily testing coverage plus masks except when eating or competing and social distancing where possible. I fear with biweekly testing (without 100% coverage) and only isolating the positive cases in many cases that will mean isolating after some of their contacts are already infected who will go on to infect other people before their infections are in turn detected. The current policy is that contacts should test with a PCR test but can continue as normal unless it is positive, there is a very real chance that if they were in contact very recently that they could be infected but not yet detectable even with a PCR so they could resume normal mixing with false assurance.
Ideally a testing and tracing program would isolate and test contacts to both isolate people the detected case has already infected but also to trace who was the source of the infection if they have not yet been detected. At no point has the UK government actually done this. If you look at how Australia and New Zealand trace cases very thoroughly you can see how effective this can be but it is resource intensive so it only works when cases are kept very low.
Ventilation
There is actually some news on this front in terms of CO2 monitors that the government will be providing (although there are no expected delivery dates yet to my knowledge). The CO2 level gives an indication of whether the ventilation is sufficient for the occupancy of the space. High readings indicate substantial portions of the air has been breathed out already, this is then a proxy for the risk level if there is an infected person in the room. High levels can also cause drowsiness and impair mental performance so regardless of COVID monitoring it is a good idea. However measuring it won't actually do anything unless changes are made based on it.
Opening windows / doors. This is already in the local policies and recommended by the government. A through draft is ideal and from a covid perspective ventilation should continue after the room is empty (although that has to be balanced with fire risks as fire can spread more easily with open doors). Until CO2 monitors have been deployed and measurements taken while the rooms are occupied I don't know whether ventilation is adequate.
If natural ventilation is inadequate an option is to install air purifiers using HEPA filters to remove the aerosols carrying the virus from the air. They won't actually affect the CO2 levels so if they are used the COVID risk level will be lower than a CO2 level would suggest. If these are needed in some rooms I would be open to making a donation to the school to support making it safer for all.
Remote Learning
The current largely unreasonable expectation of the government is that schools offer high quality remote learning for those self isolating due to infection in addition to having the vast majority of students onsite for normal lessons. In my view providing high quality remote learning would be very challenging while normal classes are also in operation. If particular forms (in years 7-8) or whole year groups (any year) are largely remote I do believe a high quality remote learning experience can be delivered. I do worry that current government guidance pushes hard against going largely remote at any infection levels that don't immediately threaten NHS hospital sustainability (which means VERY high infection rates now that most older people are vaccinated).
My preference would be to move to a partial remote learning in a more controlled way before the cases get out of control. Some students who really need to be in because of home situations or because they struggled with remote learning in the winter should be in school. For the year 7s it may be critical to get them in together to meet each other for at least few weeks and the benefits may be worth the risks that would remain. Other lessons such as practical lessons may also be priorities that are worth taking additional risks to enable. If the timetable could be adapted maybe different groups could be in on different days and those lessons most requiring equipment or in person contact could be prioritised for those days. I know this may be somewhere between hard and impossible to schedule but we every lesson that can be moved to remote learning reduces exposure between students and it is worth thinking about how to minimise the impact to education while still reducing some contacts.
No Assemblies
Indoor large group mixing at a time of such high case rates is risky. Hopefully they are being kept short and the room well ventilated. The risk is probably somewhat mitigated by the volume of the room (high ceiling).