The tide is turning

Monday 24 May 2020


There is much talk about school closures at the moment

There is much talk about school closures at the moment


The tide is turning as I look around me in London. There is the beginning of a return to some form of normal life. People are coming back to their capital after isolating in the country. The apartments around me, which have been empty for the past three months, are once again showing signs of activity.

No longer is it safe to walk down the middle of the road, happy that a car is not going to squash you. No longer is it safe to leave my front door slightly open, knowing that Burglar Bill was in lockdown, too. I now hear music being played too loudly, I see rubbish being placed carelessly in the street and sense, whatever the government says, lockdown is coming to an end. At least this version of lockdown. There will, I am certain, be other versions to follow. London, which for a brief moment in time has been London Village, is beginning to transform once more into London, the bustly capital. It will take a while to get there, of that I am certain, but change is afoot right now.

Dominic Cummings - he was said to have been a naughty boy during lockdown (AFP)

Dominic Cummings – he was said to have been a naughty boy during lockdown (AFP)

The news is much less about disease and its manifestations, deaths, misery, and families torn apart. The politicians are now point-scoring madly and recriminations are multiplying by the day. The Prime Minister’s Chief Adviser, Dominic Cummings, said to be the most powerful non-politician in the land, has been accused of breaking lockdown rules. Despite this, the Prime Minister is backing him. I understand the accusation, happen to side with Cummings, but there is more discussion now about his behaviour than the disease.

I recently heard Grant Shapps, the Transport Secretary, make some astonishing announcements, including an at least partial reversal of the Beeching closures. If there was ever an individual in the UK’s more recent history who has come in for long-term and universal condemnation, it was Beeching. For a short but notable time he was the Chairman of British Railways. His reports in the 1960s resulted in the closure of more than half of the country’s railway stations and 5000 miles of line. It was called the Beeching Axe. The country has been living with the consequences ever since. Grant Shapps has decided to reverse at least some of that and, as he spoke, my heart lifted. It then came to question time by the journalists after Shapps’ announcement. Shame on them. Their sole interest was about the Prime Minister’s Chief Adviser and whether he was culpable for what he did.  No one asked anything about the historic announcement being presented.

I could not believe it, Shapps could not believe it, but I then realised that this viral pandemic is already being elbowed into history and mankind is unlikely to learn many lessons from the experience. The disaster, and it is a disaster, is being kept in the shadows as it has proved to be an experience that most governments have failed to properly handle. No government wishes to publicise its errors.

I was astonished today to hear Lord Hall, the Director General of the BBC, saying how well the BBC had done during the pandemic. I would agree with that view in the early days of the crisis, but I would not agree now. The BBC appears to have become witch-bitten once again and presenting itself as some self-appointed political opposition. In my various healthcare roles these days I talk to plenty of radio listeners. Not one has a kind word to say about the BBC, certainly not its news. If I want to feel relaxed, the last thing I do is listen to the BBC. Well before lockdown began, the country’s Culture Secretary declared, “The BBC needs to be closer to, and understand the perspectives of the whole of the United Kingdom.” I know for certain that the BBC does not reflect mine.

Beeching - he closed more than half of the country's railway stations

Beeching – he closed more than half of the country’s railway stations

The NHS administration staggers onwards. I find it remarkable that it achieves anything at all. Today I received my fourth, yes fourth, Disclosure and Barring Service clearance since the crisis began. Most will only receive one, and even then it is valid for at least three years. Four in three months must be heading towards a record.

The Thursday clap is also changing. Annemarie Plas, a Dutch national who lives in London, started it nine weeks ago. Since then, at 8 p.m. each Thursday, the nation has come to its front doorsteps, or stood on its balconies, and clapped for those who have been involved in healthcare. But the event is now becoming politicised and for many, less enthusiastic. It is perhaps best to cut while the going is good, so Annemarie Plas has recommended that next Thursday, 28 May, should be the last occasion we clap. Good for her. I would welcome the excuse to stop.

There is move afoot to eliminate rough sleepers, although some of those I pass these days appear to be happy in themselves. For many, rough sleeping is an unfortunate end to a steady decline in life, so 6000 supported homes are apparently to be constructed. More than half will become available in the next 12 months. During the pandemic, many rough sleepers were brought under cover. For plenty of them it was the first time they had seen proper shelter in a very long time. It would certainly be good to see the streets of London free of homeless people, as they appear to have multiplied in the past few years.

There is plenty of debate at the moment about whether schools should reopen. The government would like to see this happen, at least in embryo form, on 1 June and then more so as the year progresses. The teachers’ unions have declared that they are unconvinced it is safe to reopen schools and some local councils have also objected. It is true that only a handful of UK patients under the age of three years have died of Covid-19. It is also true that children are 56% less likely to be infected in the first place. Contact tracing studies have shown that children are rarely the first person in a family to contract the disease.

As of 18 May, 2330 (1.6%) of the 144,127 confirmed Covid-19 cases in England were among people aged less than 20 years. There were 1028 (0.7%) cases in the under-10s. Key to the return-to-school decision is whether children can pass the disease on to others and the evidence about that is weak. For example, there was a paper published in mid-April that reported the events connected with an Englishman who had stayed in a French ski chalet in early February. This led to a child becoming infected, who then visited three schools while harbouring SARS-CoV-2. It appears the child did not transmit the infection to anyone else.

From Australia came some research, albeit not peer-reviewed, to suggest that children are unlikely to be the primary source of household Covid-19 infections. This Australian study matches with results from other countries, too. A child, it seems, is more likely to get the disease than to give it. Yet it is not impossible for a child to transmit infection. This same Australian study showed that of 31 household transmissions, three (9.7%) had a paediatric index case. This is in contrast with certain other infections, for example H5N1 influenza, where 54% of transmission clusters started out with children.

The situation this morning - 24 May 2020 (courtesy Center for Systems Science and Engineering at Johns Hopkins University)

The situation this morning – 24 May 2020 (courtesy Center for Systems Science and Engineering at Johns Hopkins University)

To know more about how children can transmit Covid-19 is clearly essential. Earlier research has shown that school-age children are critically important for influenza transmission in the general population. School closures may have a positive secondary effect on others with whom the children come into contact. However, the information is mixed and by no means convincing. School closures are often associated with restriction of other activities as well, so it is difficult to separate out the sole effect of the school closure. During the so-called Spanish ‘flu pandemic in 1918 a survey of the cities by the US Public Health Service during 1919-1921 failed to demonstrate any differences in illness rates between cities that closed schools and those whose schools remained open.

The situation was different during the 1957 influenza pandemic. This was created by the H2N2 virus and became a full epidemic in the USA in the autumn when the schools returned. When the schools were closed in the United Kingdom that year, estimates say that the epidemic was reduced in size by 12.5-14%.

What is clear is that calculating the effects of school closures and reopenings is imprecise at best. The simplest conclusion is perhaps from a UK paper that was published in 2014:

Simulation studies suggest that school closure can be a useful control measure during an influenza pandemic, particularly for reducing peak demand on health services. However, it is difficult to accurately quantify the likely benefits.”

I would second this conclusion, for certain. But there is an even greater caveat. These days we are not discussing influenza anyway. Covid-19 is an entirely new disease and, each day, it shows us something different.