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2. March - April 2020 "No child is known to have passed on Covid-19 to an adult"
Part 2: Review of UK's evidence base on Covid in Schools
"Children and schools don't play a significant role in transmission." Was the narrative throughout 2020 and “schools reflect community transmission continues to be the official line from UKHSA.
While UKHSA and SAGE had a lot of expertise to draw on, a few individuals were key to developing the UK's evidence base on covid in children and schools.
Part 2 of the Review of the UK’s evidence base on covid in schools looks at the several key experts and the evidence base that resulted in the headline “No child is known to have passed on Covid-19 to an adult”.
Russel Viner has recently been appointed to the post of Chief Medical Officer for the Department of Education. He was President of the Royal College of Pediatrics and Child Health at the start of the pandemic, his term ran from 2018 to 2021. With a background as an advisor to government Health and Education departments Viner was invited to join the UK government’s Scientific Advisory Group for Emergencies (SAGE) in the spring of 2020. He was also Senior Investigator for the National Institute of Health Research from 2016-202, and was awarded a CBE in the 2022 New Years Honours list.
Alongside Shamez Ladhani the UKHSA’s clinical lead for covid in children, Viner has been one of the most influential paediatricians on the subject of covid in the UK and is widely quoted in many other countries too. In early 2023 he was named on over £17 million in current research grants, 8 million of which he is the Chief/Principal Investigator.
27 March Elsevier
27 March 2020 the Dutch academic publishing company Elsevier produced a report on covid in children. Elsevier is the parent company for a number of high profile scientific journals such as The Lancet, Cell, ScienceDirect, Trends and the Current Opinion. The report’s authors included Russel Viner and Rachel Harwood who has been involved in UK agencies including the JCVI.
The report asked “How do we ensure that we do not overtreat children with a self-limiting illness or miss the handful of children with severe or life-threatening disease?”
The answers included, “Personal Protective Equipment will look strange to us, but it will be absolutely terrifying for children” before going on to suggest messaging about potential harms should focus on children with pre-existing conditions. The piece concludes with a call for responsible reporting at a time of already great anxiety to prevent misinformation.
The statement about PPE stands out in what is meant to be an analysis of the science. Now into the third year of the pandemic we can see that mask wearing was not “absolutely terrifying”, after writing this Viner has repeatedly questioned if there is any benefit of wearing masks or respirators.
6 April Viner’s Systematic Review
At the start of April 2020 just over a week after the UK had gone into lockdown Viner published a Systematic Review on covid in children which concluded that the impact of school closures on overall infection rates was only 2-4%.
The paper made headlines in the UK and abroad. “School closures play a marginal role in containing Covid-19 but are key to restarting society”.
The study has been cited by Governments and health authorities around the world, at the start of 2023 it was still quoted in the Green Book which acts as a rulebook for local authorities. Anti-vaxxers also cite the paper’s inclusion in the Green Book as evidence children shouldn’t be offered covid vaccines. This proved to be an influential study on the debate around schools and Viner went on to attend SAGE and a number of JCVI meetings after members of SAGE suggested in their meeting on 7 April 2020 that involving Viner in their discussions may be helpful. The minutes haven’t recorded whose suggestion this.
The value of the study has been called into question by many in relevant fields, and its continual inclusion in the Green Book is a source of bafflement. In Spring 2020 the available research and data on covid in children was minimal, to compensate Viner searched academic databases for relevant studies to compare, picking out 16, the majority were not on covid, they were on SARS, MERS, Influenza and other coronaviruses.
Of the six papers on covid, five were pre-prints with limited data mainly focusing on Beijing and Hong Kong, both being areas that had introduced restrictions shortly after their first confirmed case, the sixth study was modelling from the UK. Viner’s analysis was that there was very little data or evidence regarding the impact of school closures, and the evidence collected provided a wide spectrum of possible impacts, with this limited evidence Viner concluded schools had little impact on transmission, noting that the economic and other harms of school closures were well known. The assumption appears to be based on the idea the virus would work its way through the population anyway, so school closures would cause harm while only delaying inevitable infections.
The mathematician Sarah Rasmussen ( Cambridge University and Harvard) made a formal complaint to the UK Statistics Authority regarding the systematic review. Some quotes from a thread she posted on Twitter explaining her concerns.
“The Review’s Summary claim that "school closures alone would prevent only 2-4% of deaths" is a badly mis-contextualised statistic from --wait for it– the very Imperial College study  that prompted the UK government to close schools.
Viner's Review entirely omits the IC study's main predictions, like that school closures would prevent 2-fold exceeding ICU bed capacity, with COVID only taking up a fraction of ICU beds.”
“Also omitted? The Summary never hints that all 5 of the Review's other included COVID-19 studies unanimously support school closures. Still... most of the Review's included studies are used for their reference to the 2003 SARS epidemic. That's where the real problems begin.”
“The Review's selection criteria insist on "quantitative studies" that "model or empirically evaluate" the impact of school-related measures on coronavirus spread. But for 5 of their 9 included SARS studies, not a single datum they use has any bearing on the spread of SARS.”
“One article is a 2008 qualitative survey of Canadian nurses on concerns about future epidemics. Viner twice implies this article discussed nurse hardship caused by SARS 2003 school closures. But that's false: with only 250 SARS cases, Canada didn't even *use* school closures.”
Criticism of Viner’s review wasn’t covered in the UK media or further afield despite it becoming a key paper in setting the narrative throughout 2020 that children were less likely to be infected and were less infectious.
Viner’s work was in partnership with a website for paediatricians called Don’t Forget The Bubbles.
Don’t Forget the Bubbles
Don’t forget the Bubbles description from its website.
“Don’t Forget The Bubbles was conceived as a way of sharing our collective knowledge. What started out as four enthusiastic players (Tessa, Ben, Henry and Andy) has grown so much bigger. With over 70 authors and more than 600 blog posts many people might wonder just where to start. Keeping track of every post can be a challenge and so here is a little something to get you started… “
Mainly based in the UK and Australia the website for paediatricians created a special information hub on 4 April on the subject of covid and children, this was done in partnership with the Royal College of Paediatrics and Child Health that Viner was president of at the time. This section was last updated on 16 August 2021.
Viner’s systematic review seems to have been a foundation for Don’t Forget the Bubbles.
“Low case numbers in children suggest a more limited role than adults”
“Children are half as likely as adults to acquire the infection given equivalent exposure”
“Little evidence in the literature of larger outbreaks within secondary schools”
“A small increased risk for children with co-morbidities”
“Complications…do not appear disproportionate to those from other respiratory viruses.”
“Only a small increased risk to pregnant women and newborns”,,
While the website is still busy with activity the hub has had few updates or new papers after 2020 besides a paper produced by Shamez Ladhani.
Several individuals involved with Don’t Forget The Bubbles are also members of the RCPCH and worked closely with Viner and Ladhani. Sunil Bhopal is also mentioned in the #HARTleaks as providing support for UsForThem. Founded in May 2020 and launched via the Telegraph with the support of a top US law firm with UK government contracts and the PR services of Ed Barker (Vote Leave, Johnson leadership campaign, Legatum, Conservative Way Forward, the Covid Recovery Group of MPs etc), UsForThem have campaigned against every measure to reduce infection in schools and children while promoting disinformation particularly around vaccines.
The most notable member of Don’t Forget the Bubbles is Alaisdair Munro who was appointed in March 2020 by the RCPCH to lead their review of published evidence regarding covid in children. In an interview Munro explained that Don’t Forget the Bubbles came to the RCPCH’s attention as it was one of the only sites compiling an evidence base on covid in children, however the studies compiled seem to only consist of those that supported a narrative that transmission in schools was not a concern.
A registrar in training, Munro’s reassurances that covid in children was benign.quickly developed him a reasonably large social media audience and regular quotations in newspapers. With the support of RCPCH and the UK government Don’t Forget the Bubbles became an influential resources in paediatric circles and was even cited by the WHO.
He was also appointed to the National Institute for Health Research's working group on Transmission of Covid in Schools, and a number of phase 1-3 vaccine candidate trials including the Oxford Astra Zenica vaccine.
Lack of evidence of transmission was consistently misrepresented as no evidence of transmission, any studies that contradicted this stance were dismissed by RCPCH and Don’t Forget the Bubbles.
It only took a month to reverse claims in March that schools must stay open to build up population immunity to the end of April when much of the media was portraying a false consensus that children were considerably less likely to be infected and were less infectious once infected. This was in time to influence the discussions that were underway by the end of April regarding how students should return to school.
A handful of experts appeared in the media every day to hammer this message home, those that called for a more cautious approach were treated as fringe extremists.
The culmination of this PR campaign is exemplified by this headline in the Daily Mail, a product of the work of the RCPCH and Don’t Forget the Bubbles.
“No child is known to have passed on Covid-19 to an adult, a medical review has found, as evidence suggests youngsters 'do not play a significant role' in transmission.” The article citing a review conducted by the RCPCH in partnership with Don’t Forget The Bubbles.
“Professor Russell Viner, of the Royal College of Paediatrics and Child Health, told the Telegraph: 'From around the world we are not seeing evidence that children are involved in spreading or transmitting the virus, but we do not have enough evidence.'
The review of 'pertinent paediatric literature' regarding coronavirus, led by Dr Alasdair Munro and published by Don’t Forget the Bubbles in partnership with the RCPCH, found current evidence 'consistently demonstrates reduced infection and infectivity of children in the transmission chain.'”
On Twitter Munro repeated the claim there was no evidence from China of a child infecting an adult. Once again the media made the mistake of confusing a lack of evidence of transmission as evidence there was no transmission, however despite the occasional caveat it seems this was the impression the reviewers wanted to give the public.
Throughout most of the rest of 2020 sections of the media continued to make the farcical claim there was no evidence of children infecting adults. Early 2021 continued with claims children weren’t involved in transmission, but when vaccination for younger age groups began to be discussed the argument was then made that children didn’t need to be vaccinated because almost all of them had already been infected. A lack of scrutiny by journalists allowed this switch in rhetoric to be made without any difficult questions being asked regarding previous statements dismissing transmission.
Question for readers
Did the experts the UK Government relied on for its evidence base on covid in children jut happen to be the ones who were most relaxed about infections in children, or were they selected due to their views?