There is now abundant evidence from many countries that most children infected with coronavirus have at most a minor illness. Only a small number have developed the apparently novel severe inflammatory illness that has attracted recent media attention and nearly all have made a good recovery.
The most vulnerable children would remain shielded at home rather than return to school. So, the children who did attend school would be at minimal risk of significant harm if they were to catch coronavirus.
What if they were to spread it to others? There is currently no evidence to suggest children transmit the virus any more than adults. The more relevant studies seem to show that children don’t play as big a role as adults in spreading coronavirus and it is unclear what impact school closures have on limiting spread.
But the extreme social distancing measures are leading to many detrimental effects on children and families. The virus has taken a heavy toll on communities including impacting on children’s mental health and social, emotional and educational development.
Many have lost incomes and are living with great uncertainty. Poverty and hunger are reflected in increased food bank use. Health services are dealing with increased levels of self-harm and suicidality, precipitated by this pandemic and the lockdown and there have been indirect casualties where families have been too afraid to go to hospital when they need to seek medical care for other illnesses.
Parents and young people are turning to alcohol and other drugs, reflected in sales figures. Child abuse in all forms is increasing. Children’s social services are overwhelmed. The protective nature of wider social interactions, in which schools play a critical role, has been lost.
There is a need to find the safest balance between the small potential for harm that can arise from spreading infection when schools reopen and the indirect harms arising from ongoing school closure.
Schools have been preparing to re-open, including changes to classes, staffing, timings and movements along with enhanced hygiene and frequent cleaning. While this is a new disease, these are established forms of infection control and will serve to reduce droplet and contact spread by minimising occasions when children are in close proximity. Social distancing is still advised in schools.
In addition, children will spend all their time within a small group of children and staff in protective “bubbles”, similar to the social distancing we are used to within families. These bubbles do not mix so if infection has spread to somebody else in the bubble, any further spread is limited.
It won’t be possible for the youngest to social distance all the time. We should try where we can, but individual brief moments of proximity between children or staff in a bubble are not expected to contribute to significant spread of virus. Many of the government’s suggested measures, such as these protective bubbles, have been adopted by other countries as their children return to school.
There is good evidence that all these measures together would be expected to reduce the risk of catching or spreading coronavirus in a school to a level that causes significantly less harm than maintaining an indefinite lockdown.
Staying home worked. It protected health services from becoming overwhelmed, helped protect the most medically vulnerable and has now brought infection rates down. But it came at a cost. Our children must stop paying this price. The plan is for schools to have a phased reopening from June in a way that continues to keep the NHS and the most vulnerable safe.
We owe it to our children to protect them from the significant indirect harm of this virus as much as any small direct harm.
And that means going back to school.
Dr Weil is a public health consultant and assistant director of Public Health at Camden and Islington Public Health Team. Dr Cohen is a consultant in paediatric infectious diseases at University College London Hospital
