Coronavirus (COVID 19): Advisory Sub-Group on Education and Children’s Issues minutes: 7 September 2021

Attendees and apologies

Advisory Group members:

• Carol Tannahill (Chair)
• Gayle Gorman
• Prof Marion Bain
• Dr Eileen Scott
• Prof Ian Rivers
• Prof Devi Sridhar
• Prof Julie Fitzpatrick
• Catherine Agnew
• Gaenor Hardy
• Prof Chris Chapman

Observing:

• Prof Linda Bauld

Apologies:

• Dona Milne
• Iona Colvin
• Prof Brigid Daniel
• Prof Paul Flowers
• Public Health Scotland:
• Diane Stockton
• Colin Sumpter
• Shifa Sarica

SG (observing):

• Liz Levy
• Daniel Kleinberg
• Marianne Emler
• Andrew Drought
• Niamh O’Connor
• James Wilson

Secretariat:

• Sam Anson
• Judith Tracey
• Judith Clark

Items and actions

Welcome

The meeting was chaired by Carol Tannahill. The Chair welcomed members to the meeting and provided a brief update on actions from the previous meeting.

The Chair welcomed Professor Linda Bauld, Usher Chair of Public Health at the University of Edinburgh, to her first meeting of the sub-group. Linda will be taking over from Carol as Chair when she steps down at the end of September 2021.

Minute of meeting on 24 August

The minute was confirmed as an accurate record of the meeting.

Review of evidence

The sub-group considered the latest data on the state of the epidemic. The increase in case rates was slowing in all age groups, and was plateauing overall, with decreases in some age groups. 91.2% of the adult population and 58% of 16-17 year olds have now been vaccinated with one dose. 83.1% of adults and 8% of 16-17 year olds have received a second dose. By 25 September 2021, it was estimated that all teachers who have taken up their first dose, will have been offered their second dose and have had 2 weeks to develop a second dose response.

The number of patients in hospital and admissions to ICU had increased in the last week, and it was noted that it will take time for any decrease in case numbers to impact these figures. Although the numbers of children in hospital with COVID had increased, this was reflective of rising case numbers, with the proportion of cases in children requiring hospitalisation remaining consistently low. There were 48 registered COVID related deaths in the week to 29 August, with the Delta variant remaining the dominant strain in Scotland. 

It was noted that recent data shows that there was already a rising trajectory of cases from early August i.e. before the return to school, although that return will also have had some impact on case numbers. Work is underway to consider possible reasons for the inflection occurring in early August, including comparisons with data from England.

Action:

• sub-group secretariat to share comparisons with data from England with sub-group members when this is available

PHS gave a brief update regarding the evidence on transmission, noting that studies have shown limited transmission of the virus from children to school staff, as well as the lower risk of severe COVID-19 for teachers compared to the general working-age population. The REACT case control study found that the risk of severe COVID-19 is not raised by living with a child, though it is raised by living with another adult. However, it should be noted that, in the main, studies were carried out before the more transmissible variants of the virus became predominant, and before vaccination programmes had been rolled out in the general population. Additionally, the current difficulty of international comparisons in light of differences in variants and vaccination rates was highlighted.

School absence analysis

The sub-group received an update on current school absence data, which showed a significant increase in COVID-19 related absence on Friday 3 September compared to the previous week. It was estimated that if the previous self-isolation policy was still in place, and the same ratio for pupils self-isolating per pupil case on 4 September 2020 was applied to the current rate of COVID-19 related sickness, there would be over twice as many pupils not in school due to self-isolation. It is important to note that each pupil case does not lead to a uniform number of corresponding isolations, and this is based on the average numbers of contacts. 

Mitigations in schools and ELC settings

The sub-group discussed whether the current evidence supported any move to either strengthen or ease current mitigations in schools and ELC settings. Sub-group members agreed that, given the very high case rates and current evidence on the state of the epidemic, it would not be appropriate at this time to consider any further easing of mitigations. Equally, given the success of the vaccination in weakening the link between cases and severe harm, there was not a need to strengthen mitigations at this stage. Instead, the current mitigations should be retained for the moment. The situation will be kept under active review and will be considered again at the next meeting on 21 September.  

Action:

• the issue of baseline mitigations to be discussed again at the next meeting of the sub-group

Self-isolation for children and young people

The sub-group discussed whether any changes should be made to its advice on self-isolation, including if anything further could be done to support implementation and provide reassurance.

In discussion, the following points were made:

• in terms of outbreak management, while significant variation in risk for different local areas should be avoided, local flexibility reflecting public health prioritisation together with local circumstances and knowledge remains important
• the issuing of warn and inform letters across whole schools or settings where there are positive cases could cause unnecessary anxiety and/or may reduce their impact when multiple letters are received in a short space of time
• concerns had been raised by the Scottish Childminding Association (SCMA) about the self-isolation policy for close contacts which means that under 5s can continue to attend settings without needing to take a PCR test, even if the close contact is with someone in their household who has tested positive. This is making childminders nervous and they are pressing for a change in policy. Some are already refusing to take children in these circumstances

After some consideration, the sub-group agreed that changes to the definition of a high risk close contact, who would be required to self-isolate and take a PCR test, would not be proportionate given that the majority of adults and at risk groups now have protection from vaccination. Additionally, the levels of contact tracing required by schools would result in an unnecessary increase in workload for school staff.

It was agreed that it would be helpful to review the current guidance around warn and inform letters to encourage schools to take a more targeted approach. This could advise sending letters only to those groups that are most likely to have been in contact with a positive case, for example class groups, instead of sending them to entire school communities. It was felt that this would increase the impact of the letters by making them feel more relevant to recipients, while ensuring that most contacts would be reached.  

Sub-group members also advised that it would be helpful to revise the warn and inform template letters to strongly encourage recipients to take an LFD test prior to returning to the school environment. As the existing asymptomatic testing programme does not cover children in primary schools, the revised wording should encourage LFD testing for primary aged children prior to return, but should be less strongly worded than for secondary aged pupils. It was suggested that these revisions would not apply to ELC settings. The sub-group also recognised that schools and units for children with additional support needs might require some further consideration.

Action:

• Public Health Scotland to consider what could be done to provide further support to schools and units for children with additional support needs

AOB

The sub-group discussed the issue of student teacher placements in schools and visits from the tutors assessing them. The main concern with student teacher placements was less with the student teachers themselves, but with their tutors. This was because tutors can visit multiple students in a relatively short time frame and observe each student in the classroom along with large numbers of pupils. It was agreed that wherever possible virtual assessments should be undertaken. Where in-school assessments are necessary, the sub-group advised that the number of schools visited by a tutor on the same day should be kept to a minimum. It was also suggested that an LFD test should be taken prior to in-person visits by tutors.

Date of next meeting

The next meeting will be held on 21 September.