A BLANKET policy which requires entire primary school class ‘bubbles’ to self-isolate if one child tests positive for Covid is too restrictive and not based on evidence, researchers have said.
They warned that primary school children “will disproportionately experience harm” if more is not done to take account of the differences in transmission risk between young children compared with older children.
Dr Sanjay Patel, a consultant in paediatric infectious diseases in Southampton, worked with colleagues in Spain, France and Belgium to evaluate the approaches in different European countries.
Writing today in the BMJ journal, Archives of Disease in Childhood, they describe a “concerning picture” of “wide variation in recommendations across Europe”.
They write: “If they [recommendations] were evidence based, there would be relatively little variation in practice between European countries, although factors such as population density and rates of SARS-CoV-2 prevalence could justify some variation.”
The requirement for whole class bubbles to isolate in the event of a positive case applies across the UK, Spain and Germany, but not in Holland or Sweden.
In France, this is only triggered if there are three or more positive cases among the classmates, and in Belgium only if there are two or more.
In the UK, Spain and Holland, if a child develops possible Covid symptoms their household is required to self-isolate with them while they await test results, but this is not the case in Belgium, France, Germany or Sweden.
Rules also vary in relation to facemasks, which are not recommended for teachers in Holland or Sweden.
In Scotland face coverings are compulsory in the classroom and in communal areas, such as corridors, for teachers and secondary school pupils in years S4 to S6 in areas under Level Three or Four restrictions.
Evidence suggests that younger children are much less likely to catch the virus or to pass it on.
In the week ending November 22, there were 352 Covid cases among children aged five to 13, and 237 in those aged 14 to 17.
On November 26 there were 26,182 pupils absent from school for Covid-related reasons, though this has previously exceeded 33,000.
The researchers said “evidence-based recommendations for primary school” should be a priority “to avoid young children unnecessarily missing significant quantities of schooling this winter”.
They add: “Not only is there wide variation in recommendations across Europe, surprisingly few countries have implemented an approach that promotes upscaling or downscaling of their primary school recommendations in line with local prevalence.
“In addition, none of these countries suggest different measures for primary schools compared with secondary schools, except in the use of face covering and approaches to contact tracing.”
They note that young children experience frequent respiratory tract infections, averaging eight per year in pre-school and four per year in primary school.
They write: “If testing is difficult to access or slow, young children will inevitably miss significant quantities of schooling this winter.
“In addition, the recommendation in some countries for the entire family of a symptomatic child to isolate while awaiting their test results will limit parents’ ability to work and siblings’ freedom to attend school…
“The default position for primary schools should be the implementation of less restrictive infection control requirements, in which young children are not made to wear face coverings, entire bubbles are not made to isolate following a single case and the entire family is not made to isolate awaiting the child’s test results.”
The researchers call for rapid Covid saliva tests – once validated – to be “prioritised for use in school settings to minimise disruption to education”.
Covid vaccines should also be prioritised to teachers over primary school children and to children living “with extremely vulnerable relatives within their household”.
Measures could be tailored to pupils in this higher risk group, such advice to wear face coverings in communal settings, isolation in the event of any positive cases within their class bubble, and having a lower threshold for testing if they develop symptoms.
In France and Spain, gastroenteritis is included among the Covid symptoms for children, who are more likely than adults to experience diarrhoea and vomiting as a side effect of infection.
In the UK, a persistent cough, fever, and loss of taste or smell are the only official Covid symptoms.
The researchers conclude that measures such as social distancing should be escalated when local virus prevalence rises above a certain threshold to curb transmission between teachers, and from teachers to pupils.
They add: “However, apart from in the event of sustained transmission of SARS-CoV-2 within a school, we do not feel that closure of primary schools can ever be justified.”
A spokesman for the Scottish Government said: “We are keeping the way guidance is being implemented in schools under close review, along with emerging scientific evidence.
“Where there is a need to take further action, either by updating our guidance or supporting implementation, we will work with teachers, parents, trades unions, local authorities and young people’s representatives to do so.”