Are we “testing too many children”?

Amid the chaos of a government strategy that is trying to press on the brakes while putting its foot on the accelerator at the same time, a study led by Professor Russell Viner of University College London and Great Ormond Street argues that schools should be the last places to be shut, that children are less susceptible to catching the virus than adults, and that too many children are being tested.

Lets look at these one at a time.

Children are less susceptible to catching the virus than adults?

Prof Viner’s own study is more ambiguous about this than the argument he rests on it. As it says… “This study provides no information on the infectivity of children.” My emphasis. (1) In other words, once children have the virus, there is no evidence that they don’t pass it on on the same scale as adults do. This is underlined by the following observation “There is weak evidence that children and adolescents play a lesser role than adults in transmission of SARS-CoV-2 at a population level.”(1) In other words, not enough to make a definitive case. Prof Viner’s comment to the press that “susceptibility tells us a little about transmission. You have to be able to catch the virus to transmit it” (2) instead rests his whole case on susceptibility.

So, lets look at that.

The summary of the study lumps all age groups under 20 into the same category in order to make the point that – as an aggregate – they are less susceptible than adults; just over half as likely to catch the virus. There is, however, a statistical sleight of hand in this that is so obvious its embarrassing to have to point it out. There is a huge range between the youngest and oldest age groups covered in the study; which concluded that an adult level of susceptibility starts at 17 or 18, that there is less susceptibility among younger children and that there is too little data on adolescents to draw a firm conclusion.

Taking this to be the case, it means that sixth forms, FE and Universities are all institutions in which adult levels of susceptibility – and on Prof Viner’s logic therefore transmission – can be assumed. The current rapid increase in infections at Universities seems to bear this out.

If there is too little data on Secondary age students, but given that there is a clear distinction between students older than them with those younger, its reasonable to assume a rising curve of susceptibility by age (other things being equal – which – of course – they might not be). Empirical evidence since the start of term in September seems to bear this out, with a rising trend of infections among students in this age group. (3) Social distancing measures and small bubbles at Secondary level should be a no brainer given that this is the case. A “bubble” comprising an entire Secondary Year Group – which can be anything from 120 to 300 students – is wildly risky when you consider that the same students outside school can be penalised for meeting in a group larger than six. The National Education Union has proposed a series of measures to try to keep schools safe, which have been ignored by the government, but will need to be taken on board if schools are not to be shut on a wide scale. (4)

This is underlined by Office for National Statistics figures on infections which show a slight decline in infections among early years and Junior age children, but that “The current infection rates have been highest among teenagers and young adults.” (5)

Whether junior age children are less susceptible, or simply follow the well established tendency for the virus to hit the oldest age groups hardest, is a moot point. Given that Prof Viner’s report is a meta study of many different studies from around the world without a common modus operandi, it could well be that because younger children for the most part get a milder, sometimes asymptomatic illness, the scale of infection has been missed simply because they haven’t been tested. To go back to the initial point – this has no bearing on how infective they might be. So the risk factor in Primary schools – apart from the small minority of children in this age group who do get it badly – is to the educators and families that asymptomatic and untested children might pass it on to; especially where they, for cultural or economic reasons, live in multi generational households. Its a lot easier not to “go home and kill grandma” – in Matt Hancock’s delightful phrase – when Grandma lives in her own place somewhere else, not jammed into an overcrowded flat with the rest of the family.

A study from Massachusetts General Hospital (6) rings some alarm bells in this respect. They found that ” The infected children were shown to have a significantly higher level of virus in their airways than hospitalized adults in ICUs for COVID-19 treatment...Transmissibility or risk of contagion is greater with a high viral load...Alessio Fasano, MD, director of the Mucosal Immunology and Biology Research Center at MGH and senior author of the study commented. “During this COVID-19 pandemic, we have mainly screened symptomatic subjects, so we have reached the erroneous conclusion that the vast majority of people infected are adults. However, our results show that kids are not protected against this virus. We should not discount children as potential spreaders for this virus.” They further underline the vulnerability of the most deprived communities. “The researchers note that although children with COVID-19 are not as likely to become as seriously ill as adults, as asymptomatic carriers or carriers with few symptoms attending school, they can spread infection and bring the virus into their homes. This is a particular concern for families in certain socio-economic groups, which have been harder hit in the pandemic, and multi-generational families with vulnerable older adults in the same household. In the MGHfC study, 51 percent of children with acute SARS-CoV-2 infection came from low-income communities compared to 2 percent from high-income communities.

So, its clear that concern that children can both catch the virus and infect others is very far from being “unscientific” or “misplaced” as Prof Viner claims. (2)

Too many children are being tested?

The Massachusetts study therefore concludes that  “routine and continued screening of all students for SARS-CoV-2 infection with timely reporting of the results an imperative part of a safe return-to-school policy.” This is the opposite of the bizarre suggestion from Prof Viner that too many children are being tested.

His argument rests on the essentially reactive and sketchy character of the ramshackle testing regime in the UK. “There is clearly limited capacity in testing at the moment.” (2) Tests are not routine and continual, they follow symptoms and anxiety about them. Prof Viner’s argument is that too many tests are being administered to children who are exhibiting symptoms of the normal Autumn snuffles. However, since these symptoms often overlap with Covid – cough, high temperature etc – how is a school (or parent) supposed to know which is which? Is it not better to err on the side of caution and insist on the testing regime becoming adequate to the needs, rather than just crossing our fingers and hoping for the best? Just accepting that testing is inadequate is hardly a good approach. There is also a complication here in that a study by Kings College reported on the BBC Inside Science programme indicates that children’s symptoms are often not the same as those of adults – particularly including fever, headache, fatigue, and loss of appetite resulting in skipping meals. (7) In a small echo of Ibsen’s Enemy of the People (or the Mayor in Jaws) in one London borough a union Health and Safety Rep has had his school email account closed down for circulating this programme to his members, presumably on the principle that what you don’t know can’t hurt you. The Kings study is not a lightweight piece of work and a serious government would take it on board and adapt its guidance.

There is a further paradox, which is that the paucity of testing and the long wait for results to come back, means that more teachers and students with symptoms go home to self isolate than might need to do so – because – without a test result – they have no way of knowing whether their symptoms are Covid or not. This means that schools in areas with high infections are being seriously hit by staff absence and, as infections increase, more schools will have to close.

So, far from ramping down testing in schools to match its current inadequacy as a national system, we should be ratcheting it up so that it is systematic, rapid and comprehensive enough to get a grip on the virus and eliminate this risk.

Schools should be the last places to be shut

The question isn’t whether anyone wants to see schools shut down. No one does. Its a matter of what conditions are required to keep them open. The problem with the government’s approach is still that its failure to set up a comprehensive test, track and isolate system, its tendency to lean on the most optimistic possible interpretation of “the Science”, and its failure to adopt any of the measures proposed by the teachers’ union means that – as this collides with the real world and infections grow – schools will be stretched increasingly thin – as more staff go off with symptoms – and/or shut down if there are serious outbreaks. It must be borne in mind that schools were closed in March not because the government was keen to do so, but because the impact of the virus was beginning to close them in a chaotic way: as students, teachers and TAs went off to self isolate with symptoms and concerned parents started keeping their children at home as a precautionary measure.

A strategic weakness of Prof Viner’s argument has nothing to do with the science of his study. He argues that “As part of learning to live with this virus, we need to be keeping schools open.” (2) He presumes that we have to “live with this virus”. This fits with the government approach of trying to manage it with half measures – 10pm closing time for pubs and cafes – and local lockdowns – during which infections have continued to rise on the affected areas. We can no more live with the virus than we can live with climate breakdown. We have to eliminate it with a Zero Covid strategy. (8) It took the Chinese just six weeks to do this for domestic infections following this strategy. We are now six months into the sort of hokey cokey lockdown strategy favoured by this government, with another six penciled in. See Blog on this site: A Zero Covid strategy is needed both for public health and economic recovery.

  1. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2771181
  2. https://www.theguardian.com/society/2020/sep/27/too-many-children-tested-for-covid-leading-study-schools
  3. https://www.theguardian.com/world/2020/oct/02/covid-cases-among-secondary-school-aged-children-rise-in-england
  4. https://neu.org.uk/coronavirus-neu-national-recovery-plan-education
  5. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19roundup/2020-03-26#charts
  6. https://www.eurekalert.org/pub_releases/2020-08/mgh-rsc081720.php
  7. https://www.bbc.co.uk/sounds/play/m000lyz4
  8. https://morningstaronline.co.uk/article/b/socialist-labour-mps-call-zero-covid-strategy-such-new-zealand

2 thoughts on “Are we “testing too many children”?

  1. Hi Paul
    Interesting read. I think we shouldn’t be too quick to accept that young children don’t get the virus or don’t get ill from it. In my early years centre We had a 2 year old confirmed (ie went to hospital) with Covid at the beginning of March. The previous two weeks the baby room had a succession of babies who had seriously high temperatures. None tested obviously so they may or may not have had Covid. The simple fact is we don’t know much about this virus. ( it feels like we do but real knowledge will come later). We don’t know of the long term implications of this disease. We do know that living in cities damages everyone’s lungs but in particular young and old people.
    I do think we will have to learn to live with it, but not in the same sense as the Tories think we should. In the meantime we need to act cautiously, accept that society is being disrupted but That doesn’t mean that People’s are disrupted forever. We need to stop this nonsense that education is a conveyor belt from 5-21, that if you fall off it at any point then its over for you. We need to place humanity at the heart of everything we do.

    Sorry for rambling on ( pun intended, I was brought up on frankie Howard et al).

    Like

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