Blog 4 "A Risky Business" (Continued)
What Can We Conclude from This?
(i) Children have statistically no risk of death from CV19 nationally
(ii) Staff up to the age of 45 have almost no risk of death from CV19 nationally
It’s probably fair to also conclude that
(iii) Staff between the ages of 45 and 65 have very low risk of death from CV19 nationally.
(iv) Male staff (less common in Primary Schools) are considerably more at risk of death than female staff. That risk still remains low to very low.
Can Children Spread Coronavirus?
To be further clear about the risks within the school environment, this is a vital question to answer. This is very hotly debated at the moment. A very recent study from Iceland makes remarkably interesting reading:
Iceland have an ongoing track record for research into the nation’s genetics.
When CV19 became “a thing” the country’s biggest and most influential research institution DeCODE Genetics investigated many aspects of the disease. Many of the findings are reported here:
See also here: https://www.youtube.com/watch?v=24sLzSsbzV0
The CEO of DeCODE Genetics is prominent neurologist Kari Stefansson.
They took the approach that they would investigate the genetic code of the virus sequentially. That means that they recognise that for every transmission of the virus a tiny change occurs to it.
By tracking those changes, (identifying the unique genetic “fingerprint” of that version of the virus) they can identify where the various sources of the virus came from .
By way of example, they now know that most infections that first hit Iceland came from the UK. They know this because the genetic stamp of these early infections was most similar to the genetic “fingerprints” of the virus doing the rounds in the UK at that time.
They carried out a detailed study where they tried to sequence the virus spread in Iceland. In other words – identify which tiny minute mutation followed the previous tiny minute mutation. By doing this they were able to identify, in any chain of victims, who had the virus first and who they passed it on to. Put another way, for people that got the virus, they were able to identify from whom they were infected.
Their findings are critically important in terms of the view of infectiousness of children.
They ONLY found infections from adults to children. They didn’t find a single example of children passing on the virus to an adult.
There is some agreement amongst different layers of research groups that children, especially up to the age of 10 have very, very low numbers of infection from the virus.
This has huge implications for schools, as there is powerful evidence to suggest that children in school do not pass the virus between themselves, and significantly, that they don’t appear to pass the virus to the adults either.
Clearly other institutions will be carrying out further work on this issue, as DeCODE will continue, but this information is at least a little encouraging.
Are Children at Risk from the Adults in Schools:
Again – infection rates in children under the age of 10 appear to be very low.
The death rate appears to be all but non – existent. In pure statistical terms it is non – existent.
A Recent Question Mark for Children:
There are a tiny number of cases of skin infections (Kawasaki disease) for which an association / link with CV19 is being brought into question. The numbers of these incidents are extremely small and as yet there are insufficient cases to be able to absolutely conclude that CV19 is a contributing factor. Work nevertheless continues.
There is strong evidence to suggest that the risk to children in re-opened schools is extremely low. This will have huge implications for the need to socially isolate. If the scientific world explores this further, and comes to the same conclusions, it will have even bigger implications for society with, perhaps, grandparents being able to see and hug their grandchildren again.
Are Families of School Staff and Children Potentially at Risk?
The quick answer is. “Yes” – it would appear to be the case that there is some risk. But how much – and for whom?
The Icelandic study seems to suggest strong evidence that children do not transmit the disease (and further evidence that children might not get or rarely get the disease.) If this is the case – and these findings continue to be confirmed - the risk to families of children who have returned to school must be considered small.
Perhaps the greatest risk is for families of school adult staff.
I found it very surprising to hear Professor Hendrik Streeck of Bonn University suggest that transmission rates within family homes are as low as 15%. One might have expected this to be higher.
Nevertheless, there are implications in the world of risk assessment for staff members who share family homes with very vulnerable family members. Even with a transmission rate of 15% within the home – that means there will be some cases of transmission. And staff need to travel to school, engage with parents and work with colleagues. All possible opportunities for increased risk of infection.
What About Underlying Medical Conditions:
Several teams of scientists now appear to be reporting that the death rate from CV19 sits in the slightly less shocking zone of 0.1 – 0.4% than was previously thought.
If we take a figure of, say 0.3%, that doesn’t mean that it’s 0.3% for everyone. Let’s remind ourselves of what this means in the real world.
If the Infection Fatality Rate is, as suggested it, let’s remind ourselves who this affects.
1. We have UK society as a whole – a total group of about 67 million people.
2. We have the groups of people within society who have or will contract the disease. This is a smaller group than 1 above and currently much smaller.
3. Of the group who contract the virus, there is an overall rate of death of 3 people out of every 1000 who will tragically die. This means that out of every 1000 people who contract the disease, overall 997 will not die ie recover.
As we have seen earlier, older member of society with several underlying badly controlled health conditions will experience a significantly higher Fatality Rate.
Similarly, on the opposite end of the spectrum, younger members of society with no underlying issues have even less chance of dying than 0.3%.
The issue of co-morbidity (underlying health issues) is vitally important. It carries large implications for staff members who may be asked to return to school if they have such issues or they live with someone who has issues.
Whilst it’s very far from being a certainty that having a co-morbidity will result in death from CV19 if the virus is caught, there is powerful evidence to suggest that in the sub group of people who have died (remember – it’s already suggested that this is a very small group of society as a whole) the incidence of co-morbidities, especially 2 or more co-morbidities is high.
The New York State Department of Health (as reported in the “Hospitalist” website) stated that 86.7% of deaths in that state had one or more co-morbidity. The vast majority were also of the older generation.
The co-morbidities that were most associated with people who died are as follows, in according to order of prevalence.
3. Hyperlipidemia (eg issues with Cholesterol)
4. Coronary Artery Disease.
5. Renal (Kidney) Disease
7. Chronic Obstructive Pulmonary (Lung) Disease
9. Atrial Fibrillation (Clinical Irregular Heart Beats)
10. Heart Failure
It is still important to keep in mind, that the vast majority of people who died with co-morbidities were also in the much older age bracket. It’s further important to be reminded that the vast majority of people with co-morbidities who contracted CV19 recovered. However, the risk is indisputably higher.
More work needs to be done, however, identifying the precise risk to staff with co-morbidities who are going to be “in the front line” of duty.
Additionally, there are many, many people in the 45 to 65 year old group who have hypertension, diabetes and other co-morbidities that are well managed and under good control. Whilst the statistics suggest that overall, the age group is still at relatively low risk of death, staff with these conditions will want to receive more information about their personal risk (including those who have family members with such conditions.)
Is it Necessary to Come out of Lockdown?
This is a matter of policy and therefore a decision for politicians.
Nevertheless, there are numerous scientists who report that the impact on mental health for everyone, as well as the issues associated with lost education for children and the critically important blow to the economy are all devastating.
We appear to have three options:
1. Stay in lockdown.
2. Gradually come out of lockdown and achieve the infamous “herd” immunity
3. Find a vaccination against CV19
It is possible to stay in lockdown for a further period of time, and interestingly, the Chancellor of the Exchequer Rishi Sunak has announced extension of the payments for families (furlough) until October. Most commentators currently agree that this can’t carry on indefinitely.
Reports from the scientific community seem to suggest that the earliest likely vaccination will be widely available (if found – this isn’t a certainty) in approximately 18 months.
There appears to be a strong case for a careful and gradual release from lockdown
Nobel prize winning scientist Prof Michael Levitt: believes continuing with lockdown is a “huge mistake”
He cites that in America, where the health system is private, not publicly funded, hospitals are going into bankruptcy since people who are ill with other problems are not attending for medical treatment due to fear of catching the virus. This would suggest patients with cancer, heart disease, strike and other serious conditions are not engaging with health care that might save their lives.
Is this replicated in the UK? There is some evidence:
Across late March and April, there is clear evidence (ONS) that the numbers of deaths are much higher than normal.
The figures in blue are deaths attributed to CV19. The figures in green show a large increase in deaths which are NOT attributed to CV19.
It’s quite possible – even likely, that a large number of these additional deaths are people who have died of other causes such as heart attacks and strokes who otherwise would have sought medical attention.
Put frankly, coming out of lockdown has increased risks due to CV19, but staying in lockdown brings its own risk of fatalities which can’t be ignored. There is, also, apparently, a clear and indisputable correlation between suicide and economic downturn.
In addition, as previously mentioned, children’s education, the economy and mental health are seriously badly implicated by this continuing course of action.
It is good to see that lockdown has served a purpose and that death rates have fallen.
Tricky – for schools making decisions about the risk to staff in schools
1. The government has now moved to a “Test, Trace and Isolate” strategy, which is widely considered to be a positive method in dealing with the virus with the rate of infection currently under some control as a result of lockdown.
2. There are several reports of suggestions that the Infection Fatality Rate is much lower than first feared, somewhere between 1 and 4 out of every thousand people who catch the virus.
3. Within the scientific community, there are many who feel that had we known the death rate was so low (in the same general “ball park” as seasonal flu, for which we don’t lock down) – then lockdown may not have been the strategy taken, though most agree that in the uncertain times, adopting lockdown was an entirely reasonable move as the IFR as reported at the time was much higher.
4. The risk to Primary Aged children of death is almost non-existent.
5. The risk of death to workforce up to the age of 45 is extremely low.
6. The risk of death to school workforce up to the age of 65 is low arguably very low. This age group accounts for 11.7% of the already small sub set of people who have both contracted the virus and died from it.
7. The risk to male staff is almost twice as high as the risk to female staff.
8. There is emerging evidence of a greater risk to people of differing racial background.
9. There is also emerging evidence of a greater risk to people living in more challenging socio economic circumstances.
9. Schools will need to give particular consideration to staff with co-morbidities or family living in the same home with co-morbidities.
10. More information is urgently needed about risks associated with co-morbidities that are well controlled (as opposed to co-morbidities that are not under good control) eg blood pressure well managed with medication.
11. There is some strong evidence that children do not transmit the disease. Irrespective of this, heads may need to be sympathetic to parents who won’t send children in where there are co-morbidities in the household.
12. If schools are expected to receive 12 – 15 children out of every class, then they cannot be accommodated whilst also managing social distancing. For reasons mentioned above, this may not matter.
13. The risks to UK society should be helped by a thorough Test / Trace / Isolate policy well enforced. This is the current approach and should, if well enforced, remove “at risk” virus shedders from society for their potential infectious period. Of course that might include school staff, so schools will need to be prepared for a period of “staff in / staff out” as their risk is determined to increase through contact with positively tested cases.
14. Although it doesn’t impact on risk to schools, school staff will still have elderly relatives for whom the virus is a serious and major ongoing threat. Governors and head teachers will need to recognise that staff are naturally afraid and wary and some have genuine causes for a more cautious approach to attendance on the front line.
15. Many of these research projects are very recent. School decision makers will want to ensure that the relative positive outcomes are replicated in following and ongoing research projects.
16. Following on from part 1 of this blog, school staff and school premises teams will need to practice excellence in personal hygiene and disinfection to minimise the risk to school users.
17. There may be a legitimate case for not seeing parents in person, but rather contactless by phone or similar. Parents will need to take responsibility for managing their own social distancing at “pick up” / “drop off” times.
18. The data makes bleak reading for the older generation who will need love, attention and care. Sadly, it looks like they will need to stay in lockdown and self isolate until either herd immunity or a vaccine is found. Perhaps they ought to be given the choice? That, again is a political / moral question.
18. Remember that whatever you decide you will still be wrong and unpopular and absolutely everyone else will have done a better job than you (!)
19. You are doing an amazing and genuinely quite remarkable job. The level of sheer “nobility” that has been and continues to be displayed by school staff is both quite remarkable and actually world changing. The example you set for children is immeasurable. It won’t be measured by Sats or Ofsted – but it will change the way our young people think – and isn’t that what we came into education for?
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