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Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3249 (Published 27 August 2020) Cite this as: BMJ 2020;370:m3249

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Rapid Response:

Education disruption in response to a positive COVID-19 PCR must be proportionate and consistent

Dear Editor,

Swann et al clearly demonstrate that even in the rare case where a child is hospitalised with COVID-19, they are extremely unlikely to come to serious harm(1). This is some rare good news from this pandemic, along with the currently understanding that they are not primary drivers of disease spread(2). Children and young people do however continue to be hugely affected by lockdown and social-distancing policies (3).

We congratulate the government, schools, and teachers on achieving a return-to-school for the vast majority of pupils in the England, but are aghast to hear reports of mass exclusions and 14-day home imprisonment without exercise (“self isolation”) in the first few weeks of school-return, sometimes on the basis of single cases of children with positive PCR tests.

In several cases reported to us, one child with a positive PCR is leading to the two week exclusion of 100 other asymptomatic children in their year cohort or “bubble”, with no provision for home- or online-education. There is nothing to stop this recurring many times for the same child throughout this winter. On what basis? Public Health England guidance clearly states that exclusion should be made on the basis of “close contact”(4). When asked in parliament to clarify, the Secretary of State for Health Matt Hancock introduced the “bubble” concept in addition; as ever with covid-19 in England, confusion reigns supreme(5).

We urge the English Chief Medical Officer and Public Health colleagues to act urgently at a national and local level to prevent mass school-exclusion without good grounds. Until this is rectified, it is not accurate to say schools are open. The Royal College of Paediatrics & Child Health has spoken out consistently and clearly on the much greater risk to children of these exclusions over covid-19 itself (6), and is likely to be an important ally given their expertise in child health and wellbeing. We also urge BMJ readers who are school-governors, parents and members of local communities to challenge overzealous measures that are not in-line with Public Health guidance, in both the state and private sectors.

Today’s children are the future of our nation. Their education, socialisation and health are too important to be sacrificed without good reason. Without urgent action, the impact of overzealous measures will be felt for decades to come. Let us act now.

1. Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ [Internet]. 2020 Aug 27;370. Available from: https://www.bmj.com/content/370/bmj.m3249
2. Boast A. An evidence summary of Paediatric COVID-19 literature. DFTB [Internet]. 2020 Apr 3; Available from: https://dontforgetthebubbles.com/evidence-summary-paediatric-covid-19-li...
3. Bhopal S, Devakumar D. Damage of the lockdown for children and young people – let’s choose a different path [Internet]. Reachwell. 2020. Available from: https://reachwell.org/2020/09/07/sunil-bhopal-and-delan-devakumar-damage...
4. Guidance for full opening: schools [Internet]. GOV.UK. [cited 2020 Sep 12]. Available from: https://www.gov.uk/government/publications/actions-for-schools-during-th...
5. Covid-19 Update - Hansard [Internet]. Available from: https://hansard.parliament.uk/Commons/2020-09-10/debates/9916644B-878C-4...
6. Royal College of Paediatrics & Child Health. Statement on schools re-opening [Internet]. [cited 2020 Sep 12]. Available from: https://www.rcpch.ac.uk/news-events/news/statement-schools-re-opening

Competing interests: No competing interests

12 September 2020
Sunil S Bhopal
Academic Clinical Lecturer in Population Health Paediatrics
Dr Ellie Cannon, GP & Child Safeguarding Lead, Abbey Medical Centre, London
Population Health Sciences Institute, Newcastle University
Newcastle upon Tyne, NE1 7RU