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Covid-19: Delaying school reopening by two weeks would halve risks to children, says iSAGE

BMJ 2020; 369 doi: (Published 22 May 2020) Cite this as: BMJ 2020;369:m2079

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  1. Jacqui Wise
  1. London

It is not safe to open schools on 1 June, an independent committee of experts has warned, saying that before this happens local authorities must have evidence of low infection rates in the community infection and be able to track and trace new cases of covid-19.

The draft consultation report of the Independent Scientific Advisory Group for Emergencies (iSAGE) says that delaying a school’s reopening by two weeks to 15 June roughly halves the risk to children, while waiting till September is less risky still.1

The government announced on 10 May that some primary school classes in England would resume on 1 June, although the plan has been met with opposition from teachers’ unions and others, including the BMA.2

The draft report was discussed at a public engagement session on Friday 22 May supported by The BMJ and the online forum Mumsnet, with teachers, parents, and other interested parties contributing to the discussion. A final report will be sent to the government next week.

The committee’s chairman, David King, told the meeting, which was broadcast live on YouTube,3 that decisions to open schools should be “made at a local level, involving all local stakeholders, and be based on evidence of low local covid-19 infection rates.” He said that iSAGE was set up because of the need for transparency and openness and called on SAGE, the official group advising the government, to publish all its documentation and minutes.

Mathematical modelling by iSAGE estimates that the chances of a child being infected with the virus at school would be 1.46% on 1 June but 0.72% on 15 June and 0.15% on 1 September.

The group emphasised the very low risk of a child dying from the infection: 0.23 per million if they went back to school on 1 June and 0.02 per million if they returned on 1 September. For context, the daily chance of being killed in a road traffic crash is about 0.074 per million. However, it said that although it was difficult to assess the true risk of infected children transmitting the virus to other children and adults, delaying school reopening by a couple of weeks could allow time to find solutions to local challenges and set up local testing procedures.

The meeting heard calls for parents and teachers to be able to get data on local covid-19 infection rates, although the committee was not optimistic that this would happen soon.

Allyson Pollock, co-director of the Newcastle University Centre for Excellence in Regulatory Science and a committee member, said, “The lack of good local real time data is a huge issue. We are not capturing data on suspected cases and cases in the community and instead relying on hospital data and death.”

The draft report said that robust testing and tracing procedures, along with support for people and families to isolate themselves, would reduce the chance of infectious staff, parents, or children attending school.

It said that before a school could open safely it should carry out a risk assessment, including of the ability to enable social distancing. The ability for staff and children to be outside or in very well ventilated buildings or marquees would reduce infection rates, it said.

Pollock said that the government needed to look at staffing levels in schools to reduce the risk of infection. “We need a major reduction in class sizes down to around 15,” she said.

Children and teenagers seemed less likely than adults to become infected with the SARS-COV-2 virus, a systematic review and meta-analysis of 18 studies has found. The research is a preprint, and so not yet peer reviewed, and has not yet been put online (Viner R, Mytton O, Bonell C, et al. Susceptibility to SARS-COV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis). Data from nine contact tracing studies found that the pooled odds ratio for a positive test result in children, when compared with adults, was 0.44 (95% confidence interval 0.29 to 0.69).

Russell Viner, an author of the study and professor of adolescent health at University College London’s Great Ormond Street Institute of Child Health, told a Science Media Centre briefing: “Children and adolescents have a 56% lower odds of catching the infection than adults if in close contact with someone who has it.”

However, the study found that evidence remains weak on how likely children were to transmit the virus to others.

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