Schools reopening without robust COVID-19 mitigation risks accelerating the pandemic

Lead author Dr Deepti Gurdasani from Queen Mary University of London said: “It’s important to acknowledge the key role schools play in transmission of SARS-CoV-2, and make them safer so as to protect the wellbeing of children, staff, families, and the wider community.”

In the letter, the authors write: “While returning to school as soon as possible is imperative for the education, social development, and mental and physical welfare of children, not enough has been done to make schools safer for students and staff.

“Without additional mitigations, increases in transmission are likely, this time with more infectious and possibly more virulent variants, resulting in further lockdowns, school closures, and absenteeism.”

The authors say that school closures have been associated with substantial reductions over time in the effective reproduction number (Rt) across many countries (including England). In contrast, data from the Office for National Statistics’ 2020 COVID-19 Infection Survey show that the prevalence of infection among children rose above the prevalence for all other age groups before the 2020 Christmas break.

“Multi-layered mitigations can substantially reduce the risk of transmission within schools and into households,” they write. “Making schools safer goes hand in hand with reducing community transmission and is essential to allow schools to safely reopen and remain open.”

The authors make a set of recommendations, in line with guidelines from the US Centers for Disease Control and Prevention and practised in many countries, to reduce the risk of transmission in schools and mitigate the impact of COVID-19 on children and families. These include:

Physical distancing

• Use remote or blended learning to reduce footfall
• Stagger start and finish times
• Avoid mixing (eg, at school gates)
• Deploy additional staff to reduce class sizes
• Use large spaces (eg, halls)
• Quarantine applies to whole bubbles

Protections for students and staff

• Provide hand washing stations and hand sanitisers, and wash hands regularly
• Do not assume tests are 100% accurate
• Testing complements other measures rather than replacing them

Ventilation and face coverings

• Open windows and doors
• Teach outdoors (or in large halls) wherever possible
• Install High Efficiency Particulate Air filters with air cleaning devices
• No high-risk lessons (eg, singing, brass or wind instruments), except remotely
• Encourage children aged 5 years or older to use a mask (with exemptions)
• Teach correct mask fitting and use
• Remove masks only when outdoors or eating
• Safe disposal or washing of masks

Support children and families

• Allow optional remote learning, supported with technologies, funding, practical support, and skills training
• Provide for safe delivery or pick-up of free school meals
• Ensure safeguarding of at-risk children
• Record educational disruption alongside grades
• Provide mental health support to children

More information

• Letter: ‘School reopening without robust COVID-19 mitigation risks accelerating the pandemic’. Deepti Gurdasani, Nisreen A Alwan, Trisha Greenhalgh, Zoë Hyde, Luke Johnson, Martin McKee, Susan Michie, Kimberly A Prather, Sarah D Rasmussen, Stephen Reicher, Paul Roderick, Hisham Ziauddeen. The Lancet. DOI 10.1016/S0140-6736(21)00622-X
• Letters published in the Correspondence section represent the views of the authors and not necessarily the views of The Lancet journals. Letters are not normally externally peer reviewed.