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Part 2 of a series of blogs looking at the return to schools after Coronavirus 19.
Risky Business: Assessing the Risk of Returning to Schools After Lockdown
In the first of this series of blogs, I looked at the risk in school associated with the buildings and how to try to decrease risk on a daily basis. I also modelled the reason why it’s impossible to manage more than 6 pupils per class and maintain social distancing.
In Part 2, I take an in depth look at what is now known about the scientific research into the disease and the impact this has for the way we see risk to staff and pupils in school. In other words – the commodities that really matter…people.
Spoiler alert! There’s some good(ish) news and some “not so bad” news in the mix of information available. The amount known or recently observed about CV19 has grown enormously in recent weeks with research across the globe rapidly trying to catch up with spread. Whilst a continuing threat and cause of much fear, it’s fair to say there are some “chinks of light” in what feels like a lengthy tunnel.
As Governors, Senior Staff and Educators across the UK prepare for the “start of the end” of lockdown we examine what some of the latest findings might mean for our schools and workers.
The first part of the blog is available here.
As we work towards the return from lockdown, what are the key questions, all vital in the final determination of our risk assessments? If I was currently conducting a risk assessment relating to the re-opening oy my school, these are the key questions I would be trying to answer:
1. What are the risks to children?
2. What are the risks to staff?
3. What are the risks to the families of children who have returned to school?
4. What are the risks to the families of staff who have returned to school?
Please be aware – out of necessity this is a long a detailed report. Thank you for reading it – I hope it’s helpful - you may wish to grab a coffee!
Covid 19: What’s it all About?
In order to answer these key questions, we need to find out as much as we can about what the latest data tells us about the risks generally from CV19.
What is the Infection Fatality Rate for CV19?
The key information the world needs to know is – how deadly is this virus? The Infection Fatality Rate (IFR) for CV19 is a comparison of the number of actual deaths as a result of the virus with the actual number of infections.
A very high IFR would be terrifying for the human race. A lesser IFR would result in less dramatic solutions and cautions in the strategy to manage the way forward.
It is quite simply the key question.
The projected numerical answer, it appears, has been changing. As we look for the latest evidence around the world, there is an apparently interesting insight, which is, if not encouraging, perhaps less discouraging than we have previously been led to believe.
Throughout this blog, I will be presenting the outcomes of data. Although I come from a science background (I have a degree in Physics and can therefore understand complex scientific concepts and manipulate and draw inferences from Mathematical data and results.)
The information that I share comes directly from some of the world’s leading experts in the disease, along with sources so that you can find out more for yourselves. It is presented as a summary of the outcomes I would present as part of my risk assessment for governors.
Each Senior Staff member must take their own course of action to determine their own estimate of risk on their own schools, though you are most welcome and encouraged to read this
The reason we went into such a rigorously enforced lockdown was because there was a dearth of information about the disease. The virus is new and as it hit the UK for the first time, relatively little was known about it.
Information that was coming out from China was suggesting that an IFR of 5% of people who contracted the disease would die of it. Possibly even more than that.
Imagine that! CV19 is frightening enough without the thought that, with an outbreak in a typical UK classroom at least one person out of the thirty people present would die from it.
That doesn’t appear to be the actual the case. Though when we went into lockdown, reports from leading institutions, including Imperial College London, (which was significant in the way the UK and the USA changed strategy still listed the death rate as being very high.)
Why? The IFR has clarified as investigations have managed to find out more realistic numbers of actual cases. At first, this was only possible by using the number of people who had tested positive but it transpires this disease is characterised as being very mild (almost invisible) for large numbers of people, who were CV19 positive and subsequently weren’t tested but were infectious.
More recently investigations have been able to use accurate surveys of people who have antibodies within the test community to determine more accurate figures of numbers of people who have actually had the virus. As an example an investigation in Santa Clara in California determined that there were between 50 and 80 times more people who had been infected than had tested positive
Patently – we don’t want to die, and if there is a real or perceived risk to that status, it rocks us to our very core. Therefore – to get a sense of the real risk to us, the numbers matter. Very much! Very much indeed, actually!
If 2 people are tested positive for the virus and 1 person dies, then the Infection Fatality Rate (IFR) is recorded as 1 / 2 or 50%.
However, if many more people have the disease than 2, but ONLY 2 are tested and one person dies, in this scenario, the IFR is actually 1/100 which is 1%
There is a huge difference between a death rate of 50% and a death rate of 1%.
Why is this so Complicated and Why are the Numbers Changing?
The number of people across the world who are dying is an absolute figure.
In the UK, The Office of National Statistics don’t estimate “about 10 people in a specific care home” died of CV19. They use precise, specific reports. Death Certificates, ultimately.
So, gathering the number of deaths has always been, ultimately, accurate to a single digit. (It might take a little time for the data to be processed, but the death certificate will get to the right place and the stats will be updated.) We have all seen that in reported deaths in the UK so far.
Additionally, tragically, there has been a very real, very tragic individuals and families to attest to the problem
Further Complications: Getting the Numbers Correct
Even then, there is a great deal of dispute between people who are dying because of CV19 and people who are dying with CV19.
By way of example, In certain international “spikes” of cases of CV19, the average age of the victims was 81 years. Doctors have to put a cause of death on the death certificate, so even though the vast majority of the death in these spikes were of people who may very well (indeed who very likely would) have died within a short space of time to other causes, they are recorded as CV19 deaths.
If a patient who has caught CV19 also has a heart attack due to underlying health issues – should the doctor record death by heart attack or death by CV19? A moral and statistical dilemma. There are reports that internationally and in the UK, doctors are erring on the side of caution and recording all such deaths as CV19.
What is the Latest Information on Death Rates?
The disease has spread round the world now and teams of renowned scientists have been looking into the detail. They continue to do so.
Centre for Evidenced Based Medicine
Oxford University hosts the Centre for Evidenced Based Medicine. They looked into death rate recorded around the world and applied a statistical analysis of the results. They concluded that the death rates were somewhere between 0.1% and 0.4% (with a note that the 0.4% end of the scale was probably too high.)
Stanford University California
Dr. John Ioannidis is Professor of Medicine at Stanford University’s Prevention Research Centre
Dr. Jay Bhattacharya is a professor of medicine at Stanford University. He is a research associate at the National Bureau of Economic Research and a senior fellow at both the Stanford Institute for Economic Policy Research and the Stanford Freeman Spogli Institute
These two doctors carried out a study of cases in California. They investigated how many people had CV19 and went on to die.
They arrived at the conclusion that the IFR is between 0.1% and 0.2%.
A Symbol of Similar Levels of Risk?
Ioannidis went on to describe an analogy of the risk from CV19. He estimates that the Infection Fatality Rate is of the same order as Seasonal ‘flu. He calculated that the risk of death is about the same as driving to work.
That, surely, is a game changer for the world?
He did acknowledge that the virus has many differences from the ‘flu, not least that the ‘flu has a vaccine available for vulnerable people.
Professor Hendrik Streeck is a German HIV researcher, epidemiologist and clinical trialist. He is professor for virology and the director of the Institute of virology and HIV Research at the University Bonn.
He is considered to have done the most intensive investigation of this type in Germany.
He agrees that the IFR is between 0.2% and 0.36%.
An Infection Fatality Rate of 0.2% to 0.3%. What Does That Mean?
The common ground from these studies / academics is that the IFR is about 0.2 – 0.3%
That means that for every 1,000 people who contract the CV19 virus, approximately 2 to 3 patients will subsequently go on to die.
(N.B. Any one person who dies of CV19 is an awful tragedy – and there is no attempt here to disregard this. This blog is attempting, however, to put the data into a context so that educationalists can understand what the information means and how it might be applied to school environments and communities.)
Presenting this information another way, however, this means that of 1000 people who contract the virus, between 997 and 998 will survive.
That Is a vastly different picture from initial reports that were emerging from China.
(It is acknowledged that more people than this will become seriously ill – however all experts seem to identify that the vast majority of CV19 patients suffer either no symptoms or mild to moderate symptoms requiring no hospitalisation.)
What are the Risks to Children? What are the Risks to Staff?
The age profile of deaths by the virus is extremely interesting in the risk analysis for schools.
The following chart is made available from the UK Office of National Statistics:
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Statistically speaking, then the following observations can be made:
a) There is statistically no (or almost no) apparent risk to children from CV19 deaths
b) For workforce in school up to the age of 45, about 1.1% deaths of people in the UK who have died of CV19 are in this age range.
c) For workforce in school up to the age of 65, about 11.7% of death in the UK from CV19 are in the age group covering the whole school workforce.
Put another way, 88.3% of deaths in the UK have been in the age groups not associated with school work force.
The chart above compares the numbers of deaths with the population of the UK of the same age group.
To put the grim reality into context for older people, the 88.3% of deaths of people over the typical age of school workforce against the knowledge that this age group only make up 18.5% of the population.
Reversing this information – it means that, within the age group of the school workforce:
Population up to the age of 65 make up 82.5% of the population. (This is the “cohort” of school working age.)
They account for 11.7% of the total deaths up to 1st May 2020.
That is particularly unpleasant and grim reading for the older population, but it does put the context of deaths in the population up to the age of 65 ie school workforce age.
It makes even better (or to be precise… less bad) reading for the workforce up to the age of 45.
This group of population (0-45) make up 55.8% of the UK population and account for 1.1% of deaths.
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