January 2021 Education Select Committee
Jenny Harries & Russel Viner evidence
This week Jenny Harries the head of UKHSA is due to give testimony to the UK Covid Inquiry over two days. Considering her senior role in the pandemic response and her leadership of public health, Harries has been a controversial figure with many of her public comments appearing to be not just wrong in hindsight but at the time to.
With her appearance imminent its worth considering one of her public appearances that has received less attention.
On 19 January 2021 the education select committee met at the behest of its chair Robert Halfon MP to discuss the science behind school closures after the UK had gone into lockdown on 4 January. At this time the country was being ravaged by the Alpha variant seeing the highest daily death rates of the pandemic.
The expert witnesses called to answer the committees questions were:
Russel Viner, President of the RCPCH, one of the government’s main paediatric advisors, a member of the WHO’s TAG on covid in children. His much criticised April 2020 systematic review had led to claims children were 50% less likely to be infected than adults
Jenny Harris, UK Deputy Medical Officer, whose quotes include
"Children are more likely to get hit by a bus than infected with covid"
"Low transmission in schools"
"Workers at no greater risk"
"Masks don't work"
"Mass testing isn't appropriate for UK"
"Mass gatherings aren't an issue"
Osama Rahman, the DfE advisor who in a previous committee meeting had said the scientific advisors hadn’t been consulted for the DfE’s previous policy for reopening schools before retracting his statement in a carefully worded statement later in the same day.
Dougal Hargreaves, a paediatrician who had worked with Viner on multiple papers.
It seemed peculiar that a meeting on understanding the science behind school closures didn’t include any of epidemiologists, virologists or members of NERVTAG which would have been modelling outcomes for different policy outcomes to inform Downing Street. Education Secretary Gavin Williamson and Schools Minister Nick Gibb were also absent.
Those of us working in education were hoping the committee would recognise how difficult it had been to keep schools open in the run up to Christmas with chaotic temporary and partial closures, and would identify where the guidance had failed and how to improve it.
We also wanted to know why schools in the areas of highest transmission had been forced to stay open for the last few days of term under threat of being taken to court by the DfE. Looking back at this meeting, with the addition of evidence provided to the inquiry calls into question the reliability of the answers given to the committee.
Below are excerpts from SchoolsWeek’s reporting with the addition of some commentary.
Transmission
Professor Russell Viner says there's still "quite a lot of uncertainty about the roles of schools in transmission"
But Viner says the role of school children is "more clear", and younger children play "relatively minor role" in transmission "but they do play a role, and it's foolish to think they do not"
Viner says "we think that children under 12 are probably less susceptible to catch the virus", and children are "less likely to be symptomatic", but children and teenagers "socially mix" more than most adults
Viner says no clear answer yet on how much transmission is in schools or through "fairly uncontrolled mixing" outside schools
"We still remain unclear. The systematic review identified 10 papers on impact of closing schools on community transmission. They found 8 papers that found there was a protective effect, but there were 2 papers that found no impact, and they were the highest quality"
"I think in one sense it's a no brainer that if we close schools and stop children and young people mixing outside schools, you will reduce social contact, you will have an impact on community transmission" - Viner
Harries says looking at evidence to date, it's difficult to draw out transmission in school and transmission "in school children when schools are open"
"Overall what we should say is school children definitely can transmit infection in schools...but it is not a significant driver as far as yet as far we can see of large-scale community infections" - Harries
The focus just on community transmission shrinks the available pool of studies, omitting many studies focused on transmission in schools. A year into the pandemic there had been many papers published around the world so its suprising Viner could only identify 10 relevant papers for his review, and of those it was the two papers that found no impact that he deemed to be of higher quality than the others. The government’s own Children's Finish Taskforce report had cited an ONS study which found children were much more likely to be the index case in households.
There were also a lot of caveats in the answers "Uncertainty over role of transmission",
"Not enough data", "Evidence isn't clear" etc
Viner's evidence base that younger children were less susceptible to infection comes mainly from his own work and that of Shamez Ladhani, the UKs clinical lead on covid in children. Studies previously cited by him included data from June/July 2020 when infection rates were low and only some year groups had returned to in person education..
The over reliance on their own research while ignoring much of the work done internationally has been a constant criticism of the UKs approach to covid in children. This also ignored much of the work done by SAGE, during Rishi Sunak’s evidence to the covid inquiry it was revealed he’d been warned schools were the riskiest element of the government’s planning. When SAGE suggested a circuit breaker lockdown was required in September 2020 they recommended schools be included in the lockdown in order to have the required reduction in the R rate. WhatsApp conversations released to the inquiry shows that by late September schools were a concern.
Mental Health
Halfon asks Rahman and his deputy Dr Dougal Hargreaves what risk assessment is done at DfE on whether school closures will present "even worse" risk to children in terms of mental health, etc
Hargreaves says DfE is looking at how children are falling behind and impact on mental health, and are finding things "broadly in line" with external partner organisations
Rahman says "range of survey evidence" does "point to worsening mental health situation for children and young people". That is provided to colleagues and "up to ministers"
On impact on pupils, Viner says when schools were closed "we closed their lives, not to benefit them, but to benefit the rest of society". Lot of activity trying to quantify harms, but "much of the data" is from first pandemic wave
Viner says he's aware of 75 "reasonable quality" international publications on the harms to children and young people from the first wave. They tell "consistent" story - one of "considerable mental health harms"
Viner is asked what can be done to reduce the burden of mental health problems.
"I think the easy answer, the first answer, is to get children back into school as quickly as possible"
In terms of what can be done now, Viner says message to parents is that NHS is open, and we could accelerate plans to improve mental health provision in schools
It should be noted that the question asked if school closures would be more harmful for children than being infected, however the answers only looked at lockdown harms, there was no discussion regarding harms from covid such as Long Covid. Viner's assertion school closures didn't benefit children demonstrates his thinking on the subject.
In reality it is very difficult to separate the harms of school closures from the wider impact of the pandemic loss of loved ones, family finances, fear of infection and infecting others, exam and grade uncertainty etc all sorts of issues will be impacting different students in different ways.
Risk to education workers
Harries is asked whether unions are wrong in calling for schools to close because teachers are at "particularly marked" risk.
Harries says govt looks at a number of sources, including lateral flow testing in schools,
but "really important one" for unions is ONS data.
"At the moment there is no evidenced increased risk to the teaching profession or educational staff in schools, and I think that is a really important one" - Harries
This is a questionable statement by Harries, several rounds of ONS had already been released, and while the headline figures were “teachers at no greater risk”, school workers were a a high risk occupation when their data was separated out from university, colleague and other settings that were grouped as education workers. The latest ONS data was published on the same day as the select committee meeting, in her position Harries should have seen the data before publication.
The ONS data released showed that by the time schools broke up for Christmas the average rate of infection was 1.9 times higher amongst primary and secondary teachers than the general population, and 2 times higher for special school teachers.
Primary teaching assistants were three times greater and special school teaching assistants were seven times greater. The government would have had this data before it tried then aborted to reopen schools on 4 January 2021.
The favourite line adopted by the government was that “school staff are at no greater risk from infection”, however this referred to data on the outcomes of infection rather than the likelihood of infection.
The scientists are asked about early years staying open and whether there's enough evidence on risks to EY teachers.
Harries says social connections and infections risks among early years "appear to be much lower".
Hargreaves says his understanding is the plan is for the early years and primary workforce to all be included in the twice-weekly testing programme.
Hargreaves doesn’t differentiate between lower risk of being infected or lower risk from infection, it's most likely to be the later, although Viner said that younger children were considerably less likely to be infected.
Early years and primary did not end up being included in the twice-weekly testing programme.
Variants
Harries says it's likely countries are going to see "changes in mutations and new variants...over coming months and potentially years", but that "doesn't mean schools are going to have to stay in the position they are in now."
Scientists are asked when they knew about the new strain, and whether Williamson knew when he issued Greenwich direction on Dec 14.
Rahman says letter was written about 1.50pm (though sent later). Hancock stood up and mentioned the strain "a bit later in the day"
Rahman says on Dec 17 SAGE the new strain was discussed and that it "may" be more transmissive. On Dec 21, government chief scientific adviser called a meeting of departmental advisers and later that day they were sent first PHE report confirming 50% more transmissive.
Harries is asked about SAGE minutes of Dec 22 and whether it was inevitable schools would have to close.
She says there's a "balance of risk and harm", and it is only when "growth rates are rising so rapidly" that you have to "pull in the school element".
"These are simply stepped controlled mechanisms," says Harries. Over Christmas period, the strain on the NHS was seen and "unprecedented" growth in London and the south east
Asked what significantly changed over the first few days of January, Harries says CMOs recommended alert level rise to 5 on Jan 4th, which signalled "very significant risk to life" of potential overwhelming of health services
Harries says rates changed from 10s per 100,000 in some areas in the summer, "but then what we saw was a completely changing pattern which was this very rapid growth in the new variant"
Evidence provided to the covid inquiry shows the government knew about the alpha variant before Williamson threatened councils with legal action to stay open on 14 December. WhatsApp discussion show then Health Secretary Matt Hancock discussing when to inform the public about the new variant. The council threatened with legal action was Greenwich in London where the Alpha variant was responsible for rapid growth.
Harries later provided evidence to a FOI request regarding the decision to force all state schools to stay open until the end of term (private schools had already started their holidays). There has been a lack of hindsight and a refusal to acknowledge that keeping schools open in areas with some of the highest rates of transmission driven by a new variant of consequence might have caused avoidable harm with little or no benefit to students’ education.
Viner says there need to be better studies connected up across schools and the community using "genomics and genetic analysis", but there's "no way that can be done by half term" but DfE and others are looking at how things are operating
The need for better evidence via genomic tracing to better understand transmission on schools has been suggested several times including by Harries. This raises the question why genomic studies in other countries such as Germany and South Korea weren't included in the government’s evidence base, and why years later the UK has yet to conduct a genomic tracing study in schools or other education settings.
Vaccination for staff
As chair of the select committee Halfon had called publicly for education workers to be prioritised for vaccination after health and care workers. He felt this would help in easing the concerns of the education unions and its members,
Harries says vaccinating staff is "not the limiting factor to opening schools, it is community transmission rates". So once we see decline, we'll be stepping back "probably to some sort of tier system or approach and schools will reopen"
"[Schools] weren't shut because there was a specific risk in that setting" - Harries
"It is a JCVI decision but I cannot see the link between vaccinating staff and a decision to open schools sooner or later. They're not running in the same vein" - Harries
Harries comments make it clear that she wasn’t concerned about the risk to education workers, once again schools are treated as bubbles separate to the community.
Harries says that in the event schools do reopen, schools "already have very good systems of controls". She says the fact we "haven't seen vast numbers of schools with major outbreaks", we can be "reasonably reassured" system of controls are "pretty effective".
Schools had been the most common source of outbreaks in the PHE surveillance reports throughout the autumn and winter, this was despite a breakdown in contact tracing meaning outbreaks were recorded as multiple individual cases. Schools regularly faced temporary partial or full closures.
The system of controls in primary schools consisted of hand washing, opening a window and students being kept in separate bubbles, however two bubbles of 15 students could be taught in the same classroom as long as they kept to their side of the room. In secondary, bubbles consisted of year groups and there was the addition of masks, but only in communal areas and only in areas of high transmission.
Testing
Harries says mechanism for transmission of the virus hasn't changed, so measures DfE have recommended for schools previously "still apply". But new variant is more transmissible and all of those interventions will be "monitored"
Harries says doing two lateral flow tests a week "means that two tests in a week is equivalent in effectiveness and accuracy of one PCR". This is because of speed and the fact you can take positive cases immediately out of circulation
Harries adds accuracy of the tests "has perhaps been misunderstood in some circles".
"We're finding it's highly effective at probably around 80-85% at picking up cases in their most infectious period where a PCR test will pick up viral fragments but over a much longer period"
Hargreaves says no test is perfect, and "what we need to try and do is find the appropriate use of lateral flow tests in schools".
Says one use is to pick up additional cases, and there's "broad consensus" that can be useful. But concern is not "over-interpreting negative test".
"If you get a negative test it doesn't mean that you can ignore the usual mitigation procedures, you still need to be doing all of the social distancing, all of the hand washing, all of the mask wearing where appropriate" - Hargreaves.
Hargreaves says the concern is around the daily contact tracing. Aim is different: to improve attendance. "And there is at least a hypothetical risk of increasing transmission". Says there's a "huge issue of professional judgement".
It is uncertain where Harries came to the conclusion two LFD tests are equivalent to the more sensitive PCR test, the statement was questioned at the time by a number of Professors in public health, epidemiology and virology. At the start of the pandemic Harries had said that mass testing wasn't appropriate for the UK.
Masks
On masks, Viner says it's a "complex area", because evidence on masks and children and young people "is practically zero".
"Very little evidence" that masks make a "significant difference" to children and young people, meaning we have to rely on adult evidence
Viner says balance is about educational harms to development and language development that come from wearing masks against "potential epidemiological benefits"
Harries says PHE has been looking at the issue of masks in light of new variant, but older children behave much more like adults, so "in areas where social distancing can't be maintained in communal areas", then there's a "reasonable case" for masks in secondary
"But as you go down the age groups, for the reasons Russell's highlighted, it becomes less obvious that this is an overall benefit" - Harries
It should be noted that previously Harries had claimed that adults wearing masks could increase infection rates and Viner had previously said in media interviews that masks did not cut transmission in schools, later in 2021 during the Delta wave Viner said in an interview that schools would be safe because they had measures like masks, however this was after masks had been removed from schools. A policy change he had publicly supported.
Conclusions
Hargreaves says that last term, "we had broadly a system that was working. Schools were largely open and the R rate of transmission went down across most of the country"
Viner is asked if there was anything else government could have done other than the current partial closures. He says he supported the school closures "with a very very heavy heart." "When your back's against the wall, you do close schools, but schools need to be the first to open."
He adds one of the important things to think about when we reopen schools is what happens to other parts of society at the same time "We can open schools earlier if we maintain restrictions in other parts of society."
Viner harks back to June when schools started to reopen, but "much of the other restrictions had been reduced on May 26 and I think we should be thinking differently this time about the potential for us to go back to a November-style harsher lockdown"
Viner: "I think we should be thinking about schools being first to open, not opening as part of a broader reopening. In that way we may get all of our schools opened earlier. We also need to think about differential opening and are there years and classes that can open earlier"
"We saw in November that we could have a national harsher lockdown with schools open, and the R would fall. It did rise in London, and of course that was related to the new variant we think, and it rose at the end of the month" -
They argue that the previous measures were effective because R fell during the November lockdown but said these didn't work in areas due to the new variant. With the new variant now dominant they argued that the measures that failed in London would now be effective.
When secondary schools did return they had the additional measures of LFD testing and masks were worn in classrooms for around 40 school days before being removed. Primary schools returned with no additional measures and early years had stayed open throughout the lockdown.
In July 2021 it was announced that all measures would be removed from English schools for the start of the new school year. Children who tested positive for covid were expected to stay at home for five days, but parents were reminded there was no requirements to take a test. This was before the decision was made to offer vaccination to under 18s.
