Covid-19 reader: 13 August

Schools and Covid

Public Health England report

It was exam results day across the UK this week for many 16- and 18-year-olds, coming around a week after the Joint Committee on Vaccination and Immunisation (JCVI) advised that all those aged 16 and 17 could get the first dose of the Pfizer-BioNTech vaccine. This cohort will be in one sort of educational setting or other come the new school year in September, environments said to be key to the spread of Covid, but just how prevalent is the virus in schools? Less than we may have imagined, according to a study published this week.

The Schools Infection Survey (SIS) – carried out jointly by Public Health England (PHE), the London School of Hygiene and Tropical Medicine, and the Office for National Statistics – reported the results of its sixth round. Data was collected in June across 141 primary and secondary schools in England.

The researchers said that in primary school pupils, the positive rate of 0.27% was similar to that found in round five (May), with lower infection levels in pupils and secondary school staff than in the autumn term 2020. Though prevalence in secondary school pupils had increased to 0.42% in June from 0.05% in May, this was still well below the 1.48% seen in November last year. Infections among secondary staff (0.27%) was also significantly lower than the autumn term (also around 1.5%).

Shamez Ladhani, a consultant paediatrician at PHE and study lead, said: ‘Through this study we’ve closely monitored the risks of Covid-19 in schools. Latest results show that infection and antibody positivity rates of children in school did not exceed those of the community. This is reassuring and confirms that schools are not hubs of infection.’

According to the latest React-1 study (24 June to 12 July), which tests a cross-section of volunteers in England, infections among 13- to 17-year-olds in the wider community stand at 1.56%. This is a nine-fold increase on the previous study (20 May to 7 June), and, together with 18- to 24-year-olds, it is the age group with the highest weighted prevalence of positive swabs. Overall, the study showed positive cases were rising. There were 63 cases per 10,000 people, compared with 15 per 10,000 in the previous round.

SIS is not intended to offer a general picture for England’s schools, but the researchers said the fact that prevalence among pupils sampled in schools was consistently lower than in the wider community supported the hypothesis that measures taken in school, including the rapid asymptomatic testing programme, may have reduced infections.

SIS has now been completed, and does not cover the last three weeks of the academic year, when schools reported large number of pupil absences due to Covid positive tests or contacts.

SIS will add to the debate about whether younger teenagers should be vaccinated. Some will believe vaccine doses should go where they will make the greatest impact – to medium- and low- income nations with low vaccination rates, for example – while others will insist that vaccinating as much of the population as possible will make everyone in the country safer. The science journal Nature has weighed up the evidence for and against.

The JCVI is taking a cautious approach, recognising the recent spread of Covid in younger people, but balancing the risk of harm – both through potential side-effects of the vaccine and Covid infection if unvaccinated – and the benefits. It has recommended a first dose of Pfizer-BioNTech for 16- and 17-year-olds, and two doses for children 12 and older who are household contacts of an immunosuppressed person.

It highlighted the potential side effects of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the membrane around the heart), which though serious and typically occur within a few days of a second dose (mainly in young men), are thankfully rare. Prioritising the first dose for ages 16 and 17 – and delaying a recommendation on the second dose – gives time for the JCVI to gather more information.

‘The aim is for the second dose to be given later and this will extend protection for a longer period, for example when those young people start work or go to university, or if we begin to get another wave of cases in winter. It is important to keep young people well and in school in the autumn term and to minimise disruption to education as far as possible. For now, we recommend prioritising the first dose in younger age groups,’ it said.

Positive signs on attitudes to vaccination

Office for National Statistics updated analysis

With the government announcing that three-quarters of UK adults have received both doses of vaccine, with a further 14% on one dose, attention has turned to the remaining 10% or so of adults who have not yet had the jab.

While a tiny number of the non-vaccinated will be staunchly anti-vaccine, many will have not got round to it yet, and some will be vaccine hesitant – worried about possible side-effects. However, the latest analysis from the Office for National Statistics (ONS) provides some positive news on hesitancy, while also highlighting continuing reticence among some groups.

For the first time, the ONS examined hesitancy across different areas of Great Britain comparing two periods this year (7 January to 28 March, and 28 April to 18 July). This found a widespread decline in hesitancy, and this was greatest in areas with the highest initial levels – in London, for example, hesitancy fell from 11% to 7%. In the North West it fell from 12% to 7%, and West Wales and the Valleys 11% to 5%.

The regular ONS survey on attitudes to vaccination – collected in the three months to 18 July – showed 96% of adults in Great Britain are positive about the coronavirus vaccines. And while 4% reported vaccine hesitancy (the same as in previous periods), hesitancy among younger people appears to have decreased.

In the latest survey, vaccine hesitancy stood at 11% in 16- and 17-year-olds (14% previously); 5% in the 18 to 21 age group (previously 9%); and 9% in those aged 22 to 25 – a slight decline on the 10% in the previous survey. NHS England this week said that just under 30% of 18- to 29-year-olds had not been vaccinated.

Hesitancy was more marked in some ethnic and religious groups, as well as in the more deprived areas of England. For example, more than one in five (21%) of black or black British adults indicated they had concerns about vaccination. Adults living in the most deprived areas reported hesitancy rates of 8%, compared with 2% in more affluent areas, while rates among the unemployed was 12%, compared with 4% in the employed.

Nikita Kanani (pictured), NHS medical director for primary care and deputy for the NHS Covid-19 programme, said: 'Getting the vaccine is the single most important step you can take to protect yourself and others. And so if you haven’t already, I would urge you to come forward today and join the tens of millions of people who have already been vaccinated.'

Decision time on discharge scheme

NHS Confederation and NHS Providers blog

Covid, levels of demand for non-Covid care, and the need to recover pre-pandemic activity mean getting patients treated and appropriately discharged from hospital as quickly as possible is more important than ever. The NHS in England has a scheme to do this – Discharge to assess – which the NHS Confederation and NHS Providers have dubbed ‘one of the conspicuous successes of the NHS response to the pandemic’. But they say questions over funding beyond September has put the scheme in peril.

In a joint blog, confederation chief executive Matthew Taylor (pictured) and his providers counterpart Chris Hopson describe the risk that the government is about to pull defeat from the jaws of victory.

Discharge to assess had enabled thousands of medically fit patients to leave hospital, ensuring they are kept in no longer than necessary. Central funding of the scheme guarantees four weeks of care for each discharged patient, and giving the patient, their family, the NHS and social care time to make longer-term arrangements for their care.

Messrs Taylor and Hopson said NHS England and NHS Improvement data showed the programme had delivered £450m in hospital bed savings and freed up more than 6,000 staff, including almost 4,000 nurses. As well as freeing up capacity for the NHS, it has given stable funding for social care. Short-term recovery care has reduced the need for formal care and support packages, and driven greater integration with health services, they added.

It had also been good for patients, reducing deterioration in mental and physical wellbeing, as well as the risk of hospital-acquired infections.

Hospitals are currently seeing high levels of bed occupancy and this pressure will inevitably grow in the winter – this would be exacerbated if the scheme is not extended. The leaders have written to the health secretary and chancellor, calling on the government to decide on the scheme’s fate by mid-August.

They added: ‘There are few positives to come out of the pandemic but speeding up the safe discharge of medically fit hospital patients has been one of them. It feels very odd having to publicly persuade the government to continue a highly successful policy it’s introduced. But frontline health and care leaders are desperate not to lose the progress they’ve made here. The ball is now firmly in the government’s court.’