Breda O’Brien: What if children are a key source of Covid spread?
Troubling studies from other countries suggest we might be behind the science
Macedonian schoolchildren have their hands disinfected on the first day of the new school year in Skopje. Photograph: Robert Atanasovski/AFP via Getty
It is impossible to plan for something the State is constantly assuring people will never happen. Schools and creches are going to remain open even at the highest level of the Living with Covid-19 plan. But is this logical, or in tune with the latest research?
If it is not, it is likely to damage the Leaving Certificate class of 2021 just as much or more than the class of 2020. If the Government’s belief that it can keep schools open even if everyone else is huddling in personal bunkers turns out to be highly optimistic, there needs to be a clear plan in place to prioritise these highly stressed young people.
According to the HSE, 64 childcare facilities, 135 primary schools, 57 post-primary and 11 special education facilities (267 in all) have had or are having some testing after a public health risk assessment.
If there is a household outbreak, the primary case is likely to be identified as an adult and a child’s infection is likely to be seen as stemming from the adult
Mass testing resulted in the detection of an additional 113 cases. Thirty-one cases were in childcare facilities, 55 in primary schools, 17 in post primary and 10 in special education facilities. Some 6,122 students and teachers have been involved in mass testing, 15 per cent are aged over 18 and the remaining 85 per cent are under 18.
The HSE also says there has been an average of 12 clusters a week in schools. At this stage, 25 per cent of cases are in the 15-25 age group, and 9 per cent of cases are in those aged 14 or under. Despite this, the HSE is still clinging to statements such as “transmission of the virus within [any particular] school has not necessarily been established”.
When I asked the HSE what this meant, the reply was "Where a detected case has been in school in the infectious period, Public Health advise mass testing of close contacts identified in the school. Where mass testing returns an additional detected case, an assessment is done to determine if there was school transmission. This is not always a simple decision and may require further investigation."
What exactly is the nature of this further investigation? And how are close contacts defined?
Dr William Hanage, an epidemiologist at the Harvard TH Chan School of Public Health, pointed out in July that all the studies on children up until that point, particularly household studies, suffered from biases.
Children tend to have less severe illness and fewer or even no symptoms. Therefore, he says, if there is a household outbreak, the primary (or index) case is likely to be identified as an adult and a child’s infection is likely to be seen as stemming from the adult. This bias skews the identification of sources of transmission.
Household transmission is very high in Ireland. Is this bias happening here?
Troubling research has emerged from Indian and US scholars. Researchers from Princeton, University of California, and the governments of Indian states Tamil Nadu and Andhra Pradesh, investigated disease transmission patterns by examining contact tracing and testing of 575,071 individuals exposed to 84,965 confirmed cases of Covid-19. This is the largest contact-tracing study to date.
We were very slow to move to mask-wearing even when it was clear that the precautionary principle warranted it
Although children have low death rates, the study shows that those children who transmit the illness do so in high numbers even when asymptomatic. (This pertained even though at the time of research, schools were closed.)
Children aged five to 17 passed the virus to 18 per cent of close contacts their own age. When I asked the HSE about this research, their response was: “We know children can spread the disease but it appears to be very much less than other groups and our advice is based on the available evidence, especially in Europe.”
This neatly bypasses the two biggest studies to date from South Korea and India, both of which found that children transmit the disease either at the same rate or higher rates than adults. Is the science in Ireland on transmission lagging behind the available evidence?
We were very slow to move to mask-wearing even when it was clear that the precautionary principle warranted it. We ignored evidence from non-western countries and instead waited for US and UK researchers.
Are we being similarly slow regarding transmission patterns of Covid-19? The study from India relied on comprehensive and sophisticated contact tracing and testing. In Ireland, even now, our contact tracing and testing are not comprehensive or swift enough.
The teacher’s union ASTI is due to ballot on industrial action. Aside from unequal pay, the other motions stem from anxieties either about the safety of schools or unfair work practices that are being imposed under the cover of Covid-19.
Teachers’ concerns could be assuaged if they were given more access to PPE and reassured that schools would not be forced to stay open no matter what toll it takes on the health or even mortality of staff and students.
Teachers, parents and students’ concerns could be assuaged if contingency plans were in place to ensure that online education is not crippled by lack of broadband and appropriate technology.
Leaving Cert students must be prioritised. Education in school could continue for them even if other pupils were being educated at home. Everyone, not least this writer, will be delighted if those contingency plans never have to be enacted but it will be catastrophic if they are needed but do not exist.