Today sees the start of new rules that require all social gatherings in England and Wales to be with six people or less (in Wales’s children under 11 are not included in this but in England they are). Registered childcare, like schools and workplaces, are among the exemptions to this new rule (and yes that does mean you can take groups of more than six outside, as you are delivering your service not socialising). However this still caused a great deal of confusion for many PACEY members as well as other providers. The main question being asked is why are social gatherings being limited like this but children are still going to nurseries, childminders and schools and mixing in much larger bubbles?
On the face of it, this does seems contradictory but when you dig into it a little more, there is scientific evidence underpinning the choices government is making.
I attended another Chief Medical Officers’ panel briefing for organisations involved in education last week and want to share with you what I heard from the members of the SAGE panel whose focus and expertise is on children and young people. The meeting, as always these days, was virtual and a range of people representing school leaders, teachers, childcare providers as well as individuals supporting further and higher education students attended to hear from:
- Dr Jenny Harries OBE, the Deputy Chief Medical Officer for England;
- Wendy Nicholson, MBE, Deputy Chief Nurse for Children, Young People and Families and Deputy Head of the World Health Organization Collaborating Centre for Public Health Nursing and Midwifery at Public Health England.
- Professor Russell Viner, President of the Royal College of Paediatric and Child Health
The panel started with a strong message that all the evidence to date shows that children and young people are extremely unlikely to become ill from Covid-19 and generally have no or minimal symptoms if they do catch the virus. Of course this doesn’t mean they don’t transmit the virus to others. But even then there are levels of risk. The panel was clear that the evidence to date is that children under 12 are far less likely to spread the virus then children over 12. And that most cases of Covid-19 remain transmitted from adult to adult whilst in their own households. The panel was clear that evidence on children under five was limited but they believe under-fives are the least susceptible to the virus.
Whilst no one currently knows for sure why this is, the evidence proving it so is strong and based on the experience of 1000s of schools in the UK, Ireland, Belgium and Australia. Various theories why this might be were explored by the panel. The most likely contender is that childcare settings and schools are controlled environments. This means that the hierarchy of Covid-19 measures (isolating people with symptoms, handwashing, social distance where possible, face masks if needed etc.) are routinely implemented and all these measures combine to reduce the virus’s spread.
Across all this information was a clear message that the risk increased the more prevalent the virus was in our wider community. We hear about the R rate almost every day and the panel explained it remained a critical indicator for us all. The more the virus is spreading in our communities, the greater the risk of it entering childcare settings, schools, colleges and universities.
There do remain a lot of unknowns. The evidence on the use of face-coverings remains mixed according to the panel. They explained there needed to be a balance between their use without inhibiting children’s ability to learn. So helpful in crowded corridors, on public transport etc. but not in classrooms. And masks should not result in people feeling they can reduce their handwashing and use of other Covid-19 controls.
Of course, it isn’t just children in childcare settings and schools. The panel took many questions on how to support the adults working with children, especially vulnerable people including pregnant women. The panel explained how evidence was emerging every day on this issue and they were always reflecting on the risks associated with age as well as other vulnerabilities. The panel remained clear that as we do not fully understand the risks, the focus was on precautionary steps to protect these individuals. Again the hierarchy of controls remained critical and, whilst the current advice is that it is no longer necessary to shield; much depended on the R rate and levels of transmission in the wider community.
Another concern was how to manage the virus during the winter months. Many childcare settings, schools etc. are maximising the use of outdoor space whilst the summer months are with us. Lots of settings and classrooms are leaving doors and windows open to improve ventilation. As winter approaches this will be more difficult to maintain and there will be greater reliance on air conditioning systems etc. Again the scientific evidence here, according to the panel, is limited. Whilst ventilation is clearly helpful in managing the virus there are no golden rules and no strong evidence one way or another. Again good ventilation is, like face-masks, a good precaution to take. In many ways childcare settings are perhaps best placed to make the most of their outdoor spaces as winter approaches. This year, more than ever, perhaps we will need to encourage parents and children to take a leaf out of our Nordic colleagues approach to outdoor learning whatever the weather?
Finally there were questions around the emerging reports that children may exhibit different symptoms if they have Covid-19 including vomiting and diarrhoea. The panel were clear that any child with a high temperature was also likely to feel sick and have an upset stomach. However this remained a grey area in terms of formally recognising these as symptoms of Covid-19. Whilst the Chief Medical Officer regular reviews new evidence on symptoms, the advice currently remains the same. Self-isolate and seek a test for Covid-19 if you have:
- a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
- a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
- a loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal
Ultimately the panel remained clear that it’s most important message was to support children and young people back into face to face education with Covid-19 controls in place. This is because as we all know the risk and damage caused by their loss of learning was far more detrimental to them than catching Covid-19. A lack of early education and school increases inequalities, reduces life chances and can exacerbate health issues. Education improves health, learning, socialisation and opportunities throughout a child’s life and must take priority.
So, as we move into a new stage of limits to our social interactions, I hope that sharing the panel’s thinking helps you understand how it relates to the ever changing guidance we are all using to limit the impact of this virus until a vaccine is available.
Only time will tell but at least now you have a sense of the emerging research that is guiding us all as we become familiar with new routines and navigate so many unknowns, given Coronavirus is still new and we are learning more about it every day. Your reward? The happy faces arriving at your settings every day and the knowledge that, with PACEY’s support, you are doing all you can to keep the children, your staff and your families safe.
Don't forget to take advantage of the support available from PACEY on our Coronavirus spotlight. This is updated regularly as new guidance and information is published. Additionally, make sure you are following us on Facebook, Twitter and Instagram as this is where you will find all our updates.