School reopening without robust COVID-19 mitigation risks accelerating the pandemic

Our piece on safer school reopening recommendations has just been published in @TheLancet @dgurdasani1 @trishgreenhalgh @DrZoeHyde @martinmckee @SusanMichie @kprather88 @SarahDRasmussen @ReicherStephen @HZiauddeen @luke_a_johnson https://t.co/iPAKci2VYF pic.twitter.com/dqCDALiwdu

— Dr Nisreen Alwan 🌻 (@Dr2NisreenAlwan) March 10, 2021

Arguments that schools do not contribute to community transmission and that the overall risk to children from COVID-19 is very small have meant that mitigations in schools have received low priority. Yet the evidence cited for these arguments has serious limitations.4,  5 Primary and secondary school closures have been associated with substantial reductions over time in the effective reproduction number (Rt) across many countries (including England) and time periods.6,  7 In contrast, data from the Office for National Statistics' (ONS) 2020 COVID-19 Infection Survey show that the prevalence of infection among children aged 2–10 years (2%) and 11–16 years (3%) rose above the prevalence for all other age groups before the 2020 Christmas break (appendix p 4). Both modelling and real-world data in preprint showing rising cases in regions where the SARS-CoV-2 B.1.1.7 variant was prevalent during the lockdown in November, 2020 (when schools were open),8,  9 suggest that opening all schools now without robust mitigatory measures in place will probably lead to Rt rising above 1 in almost all scenarios. Modelling data by the University of Warwick and Imperial College London10 suggest that at least 30 000 more deaths from COVID-19 are estimated under the proposed reopening scenarios. Throughout February, 2021,11 despite fewer students being in school at this time, teaching staff were at higher risk of infection. Recent school outbreaks in northern Italy, where the B.1.1.7 variant is prevalent, are also concerning.12

 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00622-X/fulltext#%20