Self-Isolation: the Neglected Factor in Opening Schools

By a frontline health worker

Right wing media and neo-liberal politicians of all colours would have you believe that opening schools is a binary choice between open and close. They are pitting parents, under enormous financial and emotional pressure, against school staff under similar pressures and the unions looking out for their safety and interests. Meanwhile, children and young people are suffering the consequences, both in terms of physical and mental health and long-term effects of increased inequalities and divisions in society for the haves and have nots.

The question of whether schools are safe or not safe in the context of COVID-19 is not particularly useful or insightful: safety needs to be viewed as a balance. Experts in the health and wellbeing of children, including academics, paediatricians and the Children’s Commissioner, are all agreed that school closures have a raft of negative short term and long term consequences for the physical and mental health and wellbeing of children and young people, not to mention the impact on their education and life chances.

The benefits of schools being open outweigh risks when appropriate mitigation measures are in place – bubbles, social distancing, ventilation, etc., – and when local community prevalence is low. There are a range of local options, from setting up tents in school playgrounds to makeshift classrooms in large school halls and/or community/church halls. Localism and giving decision-making powers and resource to local public health bodies should be the name of the game.  

The government currently has set COVID policies which appear effective at reducing prevalence at a national level, but at the cost of increasing inequalities. The most important factor in determining whether schools can open safely in March is whether COVID policies can be modified to ensure an effective reduction of case numbers in more deprived areas, and also those affecting geographic, ethnic and other inequalities. It is evident from the data that infection rates in each wave are linked to social deprivation and population density in each area. Infections in the most deprived areas are falling at a much slower pace than the least deprived.

There is evidence that many low-income groups are declining tests and struggling to adhere to self-isolation for financial reasons. Many more do the same because of lack of social and emotional support if they test positive. This has been outlined in detail by Marmot et al in Build Back Fairer. Marmot outlines that there are potentially four ways that the pre-pandemic situation in England relates to the high and unequal toll on health during and probably after the pandemic:

  1. Governance and the political culture both before and during the pandemic have damaged social cohesion and inclusiveness, undermined trust, de-emphasised the importance of the common good and failed to take the political decisions that would have recognised the health and wellbeing of the population as a priority.
  2. Widening inequalities in power, money and resources between individuals, communities and regions have generated inequalities in the conditions of life, which in turn generate inequalities in health generally, and COVID-19 specifically. They augur badly for health inequalities as we emerge from the pandemic.
  3. Government policies of austerity succeeded in reducing public expenditure in the decade before the pandemic. Among the effects were regressive cuts in spending by local government including in adult social care, the failure of health care spending to rise in accordance with demographic and historical patterns, and cuts in public health funding. These were in addition to cuts in welfare to families with children, cuts in education spending per school student, and closure of Children’s Centres. England entered the pandemic with its public services in a depleted state and its tax and benefit system skewed to the disadvantage of lower income groups.
  4. Health had stopped improving, and there was a high prevalence of the health conditions that increase case the fatality ratios of COVID-19.

Better financial and social support has proven to be effective in improving testing and self-isolation in other countries. As well as ensuring a safe reopening of schools, this would allow earlier easing of all restrictions and reduce inequalities in the health/economic/social impact of COVID.

Professor Devi Sridhar proposes a three-phase approach

  1. Winter: ensure NHS doesn’t collapse. Strong restrictions on mixing.
  2. Spring: Suppress to low levels and get robust mass testing and supported isolation in place.
  3. Summer: Eliminate and protect low prevalence with border measures. We cannot have this winter repeat again.

In order to open schools as soon as possible, an effective financial support scheme for all is needed so that everyone is able to self-isolate without losing their livelihood. It is not enough to vaccinate the population. We need to have structures in place in order to stop another death toll next winter if the vaccines do not work on all variants. A wing-and-prayer last-minute approach in the manner of an undergraduate Oxford essay will not do.  The lives of our children and young people are far too important for that.

Image: Classroom. Author: Slp1, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

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