The April 2020 review that set the narrative on children & transmission
Viner's review made headlines and led to him advising SAGE & JCVI
Open schools build up immunity
12 March 2020: The UK public were told the government was pursuing a herd immunity strategy, those supporting a mass infection strategy suggested closing schools would be counter productive as the needed to stay open to help build up immunity. Contrarian commentators tried to persuade the public that a few thousand elderly and vulnerable people dying was a price worth paying to avoid lockdown, they failed, in 2020 most the public were horrified at the prospect of a cull.
A week later the government was U-turning, although they now claim mass infection was never the strategy. Critics claim they continued to follow a mass infection strategy through schools.
23 March: UK officially enters lockdown.
24 March: First day of lockdown Sunetra Gupta’s paper claiming herd immunity is on the horizon is misrepresented as being endorsed by Oxford University as it makes headlines first in the UK press and then around the world, launching Gupta’s international profile as a sceptic academic. In September she met with the UK Government just before they chose not to implement a circuit breaker.
25 March: A paper by Philip Thomas of Bristol University makes headlines for claiming a fall in GDP of 6% from lockdowns would cause more harmful than covid, the calculation was done by estimating the value of a worker dying due to lockdown as being worth five elderly people dying of covid. The next week Thomas was invited by Rishi Sunak to model a roadmap out of lockdown. No economic impact for letting covid rip was calculated.
Viner’s Systematic Review
6 April there were more positive headlines “School closures play a marginal role in containing Covid-19 but are key to restarting society”, which came from a systematic review study led by Russel Viner, then President of the Royal College of Paediatrics and Child Health, which concluded the impact of school closures was only 2-4%.
This study has been quoted widely by Governments and health authorities around the world, at the start of 2022 it was still cited in the Green Book which is a sort of rulebook for local councils. This proved to be an influential study on the covid debate around schools and Viner went on to attend many SAGE and JCVI meetings after members of SAGE suggested in their meeting on 7 April that involving Viner in their discussions may be helpful. The minutes haven’t recorded whose suggestion this.
The study was a systematic review, an analysis of relevant research and data, however in Spring 2020 available research and data was minimal, to compensate Viner searched academic databases for relevant studies to compare picking out 16, the majority weren’t 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.
While Viner’s work was making headlines others were raising concerns regarding the review. Sarah Ramussen is a mathematician from Harvard who had come to the UK to work at Cambridge University at the time. This was her analysis of Viner’s review that she posted in a thread on Twitter.
School closures + bad science (THREAD)
Remember that 6 Apr Lancet C&AH systematic review on school closures--with that media-amplified "2-4%" statistic--by a UCL team led by RCPCH president + SAGE member Russell Viner?
It has some serious problems
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30095-X/fulltext
Why does this still matter?
1. Viner's Review continues to be cited. A lot.
2. School closure was a first-aid response. Transitioning to long-term solutions calls for reexamining the science.
3. Serious enough cases of bad science raise concerns about the source.
My first alarm bell?
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 [31] that prompted 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.
Fig 3B (Red = ICU bed capacity, green vs brown = measures w/ vs w/o school closures.)
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.
1 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.
For 2+3 [34,35], Viner *solely* uses remarks about a Singapore school temperature-screening programme not finding any SARS. Except: the epidemic was already over by then! School temp screening started 30 Apr. Last 3 cases ever of that Singapore epidemic were 25&27 Apr + 5 May.
The above-right chart isn't cited in the Review. In fact, no articles that provide or analyse SARS case-count timelines for Toronto/Canada, Singapore, Taiwan, or Hong Kong are cited in Viner's Review, even for reference. Easy to find, though.
For 4th article, Viner only reports that schools and activities closed in Singapore “for 3 weeks from Mar 27" for an outbreak "from late Feb to May 2003.” Except: Feb+May had only 4 cases total. Closures started at height of the epi, +ended with avg daily case counts at 2-3.
5th [24] is a 2014 Taiwanese systematic review on planning for future epidemics. Every single SARS-related statement Viner's Review makes about this article is false. In fact, this article never spoke of *anything* related to schools from *during* the 2003 SARS epidemic.
All 5 of these articles meet multiple exclusion criteria, often even for genre. For instance [34]+[24] are (allegedly-excluded) systematic reviews. And the Review's only use of [34] is duplicated by [35], which was cited by [34]. Even so... the problems have only begun.
6th [38] is an airflow-modelling study predicting infection rate by droplets from 1 SARS-contagious person in a hospital, school room, or aeroplane, distinguished only by ventilation +occupancy rates.
More relevant than prior SARS studies, but still has problems (see inset).
7+8 [36,37], on Beijing, finally use SARS outbreak data!
The Review correctly reports these studies' scepticism on the utility of school closure, but fails to mention their scepticism on: closure of public places, travel checkpoint screening, +quarantine of low-risk cases.
In fact, they predicted healthcare facility improvements + high-risk contact tracing alone were sufficient to stop SARS.
How could this be?
Because SARS DIDN'T HAVE A/PRE-SYMPTOMATIC TRANSMISSION. SARS was completely eradicated before exceeding 8500 cases ever, worldwide.
Consider: Beijing hosted 30% of the world’s SARS cases, with 90% concentrated in one month.
The avg of the 7 *highest* SARS daily case counts for Beijing was still *lower* per population than the UK's LOWEST EVER 7-day-moving-avg COVID-19 daily case count since late March.
This transmission distinction for SARS v COVID was raised in a UK SAGE document in January and confirmed in multiple high-impact peer-reviewed studies in February.
The Review somehow skips over its cited articles' frequent allusions to this aspect of SARS. But I digress.
9th [39] is an Australian modelling study supporting school closures, which the Review does its best to de-emphasise. On the other hand, the Review entirely omits the main prediction--a 70% reduction in infections--from a conveniently-excluded, but cited, class cancellation study [45].
It also omits 2 pro-school-closures COVID-19 studies from February that contrast control measures with vs without school closures, despite implying no such studies exist, and despite these studies fitting selection criteria.
It also inserts a defacto 2nd systematic review on influenza into the Discussion section, but without stating selection criteria, and without providing crucial context, without which statistics are destined to be misinterpreted in a way that biases against school closures.
It also alters data from a Hong Kong study [27], changing the stated primary source of paediatric SARS infection from hospital spread plus an infected aerosol from leaky plumbing at the Amoy Gardens apartment complex to spread "almost entirely through family settings."
Science this problematic requires action
End of thread.
In the UK during 2020 this paper became one of the most quoted papers on covid transmission in schools and children, despite the dubious methodology it appeared in the Green Book for local authorities in 2020 and in 2021, and has been quoted by authorities in other countries, particularly those who have done less to protect their children from infection.
After Viner published the systematic review he was invited by the UK government to advise SAGE on children and covid, and was responsible for presenting evidence to the JCVI after publicly questioning the need to offer vaccination to younger age groups
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”
There is a section on PIMS/MIS-C, the severe inflammatory response that occurs in a small but not insubstantial number of children. Don’t Forget the Bubbles does note that children from certain backgrounds are disproportionately impacted.
“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”
The conclusion again says children are approximately half as susceptible to infection as adults. All sounds very reassuring, this is 2020, there was less data, there was also no vaccine.
Don’t Forget the Bubble’s also has a section of its top ten papers on different subjects. In 2020 there was much debate on how significant a role children played in transmission. Many contradictory papers were shared across the media, however the top 10 epidemiological papers on the website from 2020 contains 9 papers that are summarised as showing significantly lower transmission in children, the final paper cited found that children were becoming infected at a similar rates to adults however this is casually dismissed "Subsequent studies have consistently shown lower attack rates in children, and the reason for this discrepancy is unknown."
Paediatricians using Don't Forget the Bubbles as a resource could be forgiven for assuming the evidence base overwhelmingly supported children not playing a significant role in transmission, however one the those responsible for the hub, Alasdair Munro from the UK has argued against offering children the covid vaccine because nearly all of them had already been infected which doesn't suggest children are 50% less likely to be infected.
While the website is still busy with activity the hub has few updates or new papers after 2020 besides a paper produced by Shamez Ladhani who works with the UK government and has worked with Munro during the pandemic.
Gatekeepers
Munro is a registrar in training but with Viner, Ladhani and a small group of paediatricians from the RCPCH they became the UK governments go to professionals on covid and children. They have also influenced the debate and have had their studies quoted in other countries such as Germany and Canada.
Despite his inexperience Munro quickly gained an audience on social media with his reassuring posts. It's worth noting that while he isn't a member of Pandata and there is no evidence of him working with the disinformation group, he is in the Pandata File's list of Twitter accounts to follow and amplify. Pandata has called for children to be allowed to be infected and to act as vectors to infect parents to build up herd immunity.
When SAGE advised for measures in schools and the paediatricians argued against them, it was generally the paediatricians that the government sided with.
They produced much of the evidence base the UK government has used to justify policies that resulted in the mass infection of children.
This is the narrative they have supported.
Children are less infectious, transmission is low in schools over 90% of child infections occur outside of school, the harms of masks outweigh the benefits, don't test children, benefits of ventilation and filtration are "expensive untried technology", children's immune response to infection is so broad and long lasting that they don't need vaccination, long covid is very rare and no different to other post viral symptoms.
Members of this group also provided evidence to the JCVI when it initially concluded not to recommend vaccination to 12-15 year olds. Minutes of the meetings preceding the decision made reference to a broad immunity conferred by infection and the idea of booster infections in adults.
They have acted as gatekeepers on the impact of covid on children, those that are more concerned about the repeat mass infection of children are labelled alarmists or are accused of misinformation. Data and papers that others experts see as not matching the paediatricians perspective like the ONS data on long covid in children are dismissed as inferior to their own.
Viner regularly argued against masks in schools for any age group, when they were introduced into classrooms he then called for them to be removed. A week or so after masks were removed he appeared on a BBC news programme and said the public should be reassured that schools had adequate safety measures with social distancing, improved ventilation and masks.
There wasn't any social distancing, schools had been told to open a window (if they had one) and masks had recently been removed, surely he would have been aware of all of this? Considering he had just spent months arguing masks were ineffective and might actually increase transmission it was odd he suddenly decided to cite mask wearing as a measure to reassure the public, particularly after they had been removed.
When a child with long covid was trolled by deniers and conspiracy theorists after appearing in an Independent SAGE broadcast the paediatricians focused on blaming Independent SAGE rather than challenging the abusers.
When a nurse appeared on radio BBC5live talking about having a ward of children with covid the paediatricians lobbied to have the clip taken down claiming disinformation, there was not an increase in children being hospitalised. Data later released showed hospitalisations had increased.
One of the group also criticised posts on Twitter of pictures of children who had died of covid, considering it bad taste and disrespectful despite the pictures having been originally shared by the parents of the dead children.
They have been repeatedly critical of the American Academy of Pediatrics for supporting vaccination for younger age groups and for raising concerns regarding long covid.
The group have been particularly exercised over Independent SAGE, calling for inquiries and casting accusations of politicisation at them. However they rarely speak about harmful disinformation, for instance claims regarding vaccine harms from VAERS dumpster dives produced by groups like HART.
Two of the group of paediatricians; Sunil Bhopal and Michael Absoud were even thanked for their help and support by the group Us For Them who have campaigned against any measures to protect children from infection including vaccination, arguing that children should be allowed the “benefit of natural immunity.” Members of Us For Them have shared all sorts of disinformation including claims regarding the harms of masks and vaccines to pregnant women from conspiracy theorists such as Naomi Wolf. Bhopal is also a reviewer for the Don’t Forget the Bubbles hub.
Us For Them launched via the Telegraph by threatening legal action against the UK government claiming there was “overwhelming evidence” children didn’t play a significant role in transmission, “practically immune” is a phrase members have used. The evidence base in the legal letter prepared by the multi-billion dollar legal firm DLA Piper cited evidence from three professionals. Russel Viner’s April 2020 systematic review, a paper by Esther Crawley which on examination was simply a collection of quotes from Viner’s review, and a paper from Sunil Bhopal. Us For Them have also been aided and supported by Ellen Townsend who has been a member of multiple disinformation groups, Pandata, PCRclaims, HART, and is currently a member of Sunetra Gupta’s Collateral Global.
Viner’s review had a disproportionate impact on the debate regarding the role of children in transmission and along with the work of a small group of politicians has guided government policy. The recent BMJ covid inquiry series paper questioning the evidence behind UK schools policy had been heavily criticised from some quarters while praised in others. Its natural that those who worked with the government would be defensive of their work
