Thursday 28 May 2020

Independent SAGE confirm their warnings in their Final Report

Today, May 28, independent SAGE released its final report, updating its draft Report summarised on this blog previously, and expanding further on its previous conclusions.

Two of the key headlines in the accompanying press statement are:
  • We believe that by going ahead with a general school reopening on June 1st, the government is not following the advice of its SAGE group and is risking a new surge in cases of COVID-19 in some communities
  • Modelling from the [official Government advisers] SAGE shows R increasing if schools re-open. It notes that since it published its draft report last week, the government has also heightened the risks of a resurgence of COVID-19 cases by undermining its own messaging. (The full Report states explains that “the most recent estimates for the UK are that R is between 0.7-1, meaning that all scenarios modelled by SAGE are at risk of pushing R above 1” and that “ SAGE warned that if current R is just below 1, then even small changes could trigger a return to exponential growth.”)

The following parts of the Full Report's Q/A document particularly spell out some important conclusions:

Q) Are children less likely to pass on the virus ?

A) Recent UK and international data suggest that children are in fact as likely as adults to become infected and carry the virus and also be asymptomatic in many cases.  They may be less likely than adults to transmit the virus because, for instance, adults are contagious for longer than children. However, the impact of placing many children in one place could lead schools to become “institutional amplifiers”, if children without any symptoms go unnoticed until an adult becomes symptomatic

Most younger teachers who are healthy are unlikely to get more than a mild disease. But we know that factors such as age, being male, coming from a low income background, underlying health conditions (e.g. obesity, diabetes, high blood pressure, cardiovascular disease) and being from BAME backgrounds may make teachers and staff more vulnerable to severe disease, in particular in cities with high BAME populations. The risks for those most vulnerable and those shielding are very much higher than an adult without any risk factors. It is, therefore, important to consider the locality-based COVID 19 infection rates as the best indicator of the risk from any future school-based outbreaks.

Q) Why are they opening schools before track and tracing has been established?

A) We agree that until testing, tracing and isolating programmes are in place it is not safe enough to open schools on 1 June. It is essential that rigorous local test, track and isolate (TTI)  programmes are in place, and tested, before schools reopen to ensure that any outbreaks within or outside school are quickly spotted and contained. TTI programmes will also enable protection of high risk and vulnerable adults (including teachers and family members) and children by testing people, tracing their contacts and isolating infectious children or adults. Estimates of levels of infections must also be based on up-to-date real time, detailed, local data on suspected and confirmed cases.

Q) With the schools rushing to meet this unrealistic deadline of 1 June I fear it will become a box ticking exercise rather than attention to detail/risk factors. Given that the medical experts are constantly learning about this new virus surely it makes more sense to get the kids back out in September when more factors are clear?

A) We share some of your concerns. We have used advanced mathematical techniques to estimate how likely children are to get the infection depending on when their school reopens. Our findings show that delaying a school re-opening by two weeks (to 15th June) approximately halves the risk to children, and delaying the re-opening of school until September is significantly less risky other things being equal (much closer to zero though some risk still exists). Our modelling also showed that staying at home generally between now and September is about half as risky as going to school, but that also means that children do not get the important benefit of having face-to-face learning and being with their friends. Significantly delaying the reopening of schools to mid-June or sometime thereafter means that public health officials, GPs, local authorities, schools/headteachers have more time to prepare and find solutions to local challenges and set up strong local testing procedures while knowing that risks are getting lower.

Q) I want to know what the plan is going forward; they are just taking about the years who may go back in June but what’s the plan for the other kids?

A) Given that we cannot return all children to the same school site safely at the same time, Independent Sage suggests using a wide range of empty facilities - private schools, sports facilities and other non-school venues as examples of places where children can receive face-to-face education, pastoral and mental health support as well as physical education during the summer school term. As we go into the summer holidays this could be in the form of summer camps where social and physical development would be supported, with some education where possible. The more that educational activity can occur outdoors or, for example, in ventilated marquees, the less the transmission will be.  

It is important to recognise that this diverse provision of education inside and outside of school, with social distancing and other safety measures in place, cannot be done with the existing numbers in the school workforce. The government should therefore look to expand the school workforce during Covid-19 to allow for more flexible, diverse and expanded education provision.

Q) We live in a household where it’s me, my husband, our three children and my mother-in-law who is over 70. My mother-in-law has a weak immune system and has Rheumatoid arthritis. How can I send my primary school children to school but also make sure she doesn’t get coronavirus?

A) We believe local testing, track and isolating programmes – undertaken by public health workers, and involving local GPs, will enable us to protect vulnerable adults (including grandparents in multigenerational homes) by regularly testing people, tracing their contacts and isolating infectious children or adults.  In the situation above, parents will need to make an informed choice about sending the child to school taking into account the local infection rates and also the risk assessment of the school environment. To reduce the risk of your child bringing coronavirus into the home, it is important to ensure that your children have a shower and change their clothes when they return home.  In addition, you could ensure general hygiene, social distance at home between your children and their grandmother, and keep rooms well ventilated. The family also need to ensure that they do not share items such as towels. 

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