As a paediatrician, I share the grave concerns of nurse Ian Wilson who has two children at school in Lewisham and experience of working with covid-19 infected patients. In an open letter to Health Secretary Matt Hancock last week, he pleaded that we were not enrolled against our will in a giant experiment that could go tragically wrong, pointing out that forcing hundreds of people into small rooms in small buildings was self evidently nonsense during a pandemic (1). Nothing has changed since this letter was first published on the 20th April, other than some additional worrying scientific evidence from Germany supportive of keeping schools closed (2). This work has shown that children with mild symptoms have just as high viral loads as sick adults, considerably undermining the suggestion sometimes made that somehow children would be less infectious. It is now clear that you need neither symptoms nor coughing in order to spread disease if you are an asymptomatic carrier, since droplets are produced simply by talking (3). In close proximity, pupils would not only spread infection among themselves and teachers, but also carry the virus home to family members and vulnerable relatives.
Terrible though it is for children not to be able to go to school, and with all the attendant risk of negative impact on current health and wellbeing as well as long term prospects, there should be no reopening of school unless it is absolutely safe to do so. Not only that, teaching staff through their union representatives must also agree it is safe, and the decision cannot be left to education secretary Gavin Williamson alone. Social distancing is clearly a concept that would not be grasped by young children, and schools are usually busy and crowded places with narrow corridors and other bottle necks herding pupils together. It is absolutely right for vulnerable children to be at school at the present time, when relatively low numbers can be managed safely. More attention needs to be given to ensuring that these children are actually at school as many appear to be staying away. There are now covid free hospitals where elective surgery is being performed and perhaps this points the way forward for educational establishments. It would clearly require intensive testing and monitoring. In the meantime, more thought should be given to helping children particularly from poor backgrounds to `access study materials, for example through the loan of computers. On line learning to support home teaching has made huge strides but can also be further refined and developed. Psychological support for children should also be made available through the NHS and delivered via the internet.
John Puntis is Co-chair Keep Our NHS Public