Independent report

Chapter 8.1: NPIs in education settings

Updated 10 January 2023

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Introduction

Education is very important for multiple reasons. It is one of the best ways to:

  • reduce disparities
  • improve life chances
  • identify and respond to the most vulnerable
  • intervene in mental illness

For this reason education has important public-health positive effects including on physical and mental health in the short and long term. Schools provide a setting in which households mix, both directly through children and young people mixing in class and play, and indirectly including through parents meeting at school gates, travel and being able to return to work with additional associated social and workplace transmission risks. During this pandemic, the fundamental aims were to simultaneously reduce transmission as far as possible, both within educational settings and in the wider community, and also to continue to deliver education and support for the millions of children and young people relying on educational settings. These aims were in tension and are likely to be in tension in any future pandemic or epidemic where transmission in, or around, schools is a significant factor – for example, with respiratory pathogens, or where the risk of harm to children and young people is high. COVID-19 was a pandemic where the risks to children of the disease, while far from trivial, were found to be much smaller than for many other infections, including influenza, relative to older adults.

There was a need to strike a balance between no interventions on the one hand, which risked widespread transmission and resulting impacts on provision of education and health, and on the other hand intensive interventions that could impact education delivery and in turn social development and life chances for many children. Educational settings also provide important safeguarding functions which needed to be considered in the event of closures or restrictions in attendance. The balance shifted between these 2 broad aims at different points in the first 2 years of the pandemic.

In general, the quality of the evidence on the role of non-pharmaceutical interventions (NPIs) collected from education and childcare studies has not been strong and has largely been observational in design or based on modelling.[footnote 1] Where there is evidence, it has tended to focus on the impact on transmission or healthcare utilisation, and there remains a lack of real-world evidence on the wider consequences of control measures, including the implementation challenge and opportunity cost within the sector. All education settings including early years, schools, colleges and higher education institutions, and settings supporting children and young people with special educational needs and disabilities, have been impacted significantly by this pandemic and appropriate interventions needed to be considered for each. There is a short section below on higher and further education but, because schools tended to receive more central direction during this pandemic than many other educational settings, much of this chapter focuses on schools.

There were important differences in the pandemic experience for different types of schools. For example, special educational needs and disabilities (SEND) schools generally have higher numbers of children with clinical vulnerabilities, and experienced greater challenges implementing NPIs such as face coverings or regular testing due to the additional needs of the children and young people.

Considerations for public health advice for educational settings

As education and health are devolved responsibilities, public health measures and policies in educational settings and school attendance restrictions have varied across the UK. The clinical and scientific advice around implementing such interventions has however been continually jointly reviewed with reference to 5 main considerations:

  1. The transmission dynamics of SARS-CoV-2 within educational settings and impact on transmission of the virus across the population.
  2. The short and longer-term clinical impact of the pathogen on those within educational settings, including students, teachers and other staff, families and communities in relation to age and other protected characteristics.
  3. The public health (clinical, social, educational, wellbeing) impacts of both unmitigated transmission and of the public health interventions themselves.
  4. The evidence on the efficacy of different mitigating actions, including evidence of effect against transmission as well as any disbenefits (such as impacts on education and childhood development) or logistical challenges.
  5. Rising immunity of the population, obtained through vaccinations and prior infection, which varied by age and some other factors.

Balancing these considerations was complex, not least because the education sector is large and heterogenous. There are 14.9 million 0 to 18 year olds in the UK, accounting for 22.2% of the total population, with a wide range of settings included under the banner of education and childcare. The heterogeneity of these settings adds to the difficulty of understanding or generalising the impacts of any public health measures implemented, as does the way existing data have been collected.

On the first consideration (understanding transmission dynamics in educational settings), it is important to remember that transmission to and from children, young people and families can occur in household, community and educational settings. The infection risk from behaviours and contacts within schools is also difficult to separate from the wider ‘end to end’ behaviours and contacts taking place outside of the setting. We found in this pandemic that the majority of transmission was from children to other children, staff to staff, and within families. Several UK-based surveillance studies have provided evidence – for example, demonstrating the impact of school holidays on reducing transmission, and the relatively low transmission within schools in the early phases (wave 1, first part of wave 2). [footnote 2], [footnote 3], [footnote 4] Better links between school-based surveillance and community-based surveys would have allowed for further identification of routes of transmission between settings and communities. There is also some evidence that adolescents and older children have similar patterns of onward transmission to adults given their higher level of social mixing, and some (weaker) evidence that younger children may transmit SARS-CoV-2 less effectively.[footnote 5], [footnote 6] The contribution of asymptomatic infection in children and young people to transmission is not fully understood.

On the second consideration (the short and long-term clinical impacts of COVID-19), early research indicated a different phenotype of COVID-19 in children and young people compared to adults, with most experiencing a mild or asymptomatic form of disease.[footnote 7], [footnote 8] As the pandemic has progressed, the evidence has accumulated to show a very low risk of hospitalisation, severe disease and death from COVID-19 in this group, even for those with chronic conditions.[footnote 9], [footnote 10] A small number of children and young people report experiencing symptoms in the post-acute phase, though robust immune responses to vaccination and natural infection are seen in children and there are now high levels of immunity in this population.[footnote 11], [footnote 12], [footnote 13], [footnote 14] There is also a need to consider the particular symptom profile for children and young people. Despite reports of differing presentations, the symptom profile of COVID-19 for children and young people was generally described in the same way as for adults.[footnote 15]

A paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) was first identified in April 2020, with 216 cases observed between March and June 2020. However, rates of PIMS-TS relative to COVID-19 infection were shown to reduce over time and with the Delta and Omicron waves.[footnote 16], [footnote 17] There are conflicting estimates on the prevalence of persistent COVID-19 symptoms in children and young people, partly due to confusion over the definition and clinical phenotype. Most studies that have utilised a control group indicate a similar level of self-reported persistent symptoms between SARS-CoV-2 positive cases and controls.[footnote 18] The Office for National Statistics (ONS) estimated 1.8% of primary pupils and 4.8% of secondary pupils reported symptoms compatible with the definition for long COVID beyond 12 weeks post-infection.[footnote 19], [footnote 20] Nonetheless the impact of PIMS-TS and long COVID needed to be considered in the risk–benefit of public health advice.

The clinical risks of COVID-19 to teachers and other education staff were an important consideration, with over 1.5 million adults employed in the sector across the UK. Over time, evidence was collated to suggest that although staff working within the education sector may be at increased risk of transmission, the risk of poor outcomes, including hospitalisation and mortality were not significantly different from the general population.[footnote 21] Subsequent data showed that after adjusting for differences across occupations, the reported ability to socially distance in the workplace and work from home, there was no statistical evidence of a difference in the likelihood of testing for COVID-19 between occupations.[footnote 22] Self-reported data suggests the proportion of the population reporting symptoms compatible with long COVID may be higher in people working in social care, teaching and education or healthcare, compared to other occupational groups.[footnote 23] However, it is not possible to infer from this analysis whether the self-reported symptoms are caused by coronavirus infection.

The consideration, on the (clinical, social, educational, wellbeing) impacts of both unmitigated transmission and of public health interventions themselves, is perhaps the most complex. Case rates of COVID-19 in educational settings tended to mirror community transmission, and high community transmission rates cause disruption to educational settings through pupil and staff absence. Staff illness and absence closely correlated with community transmission and hit a peak in spring 2022, affecting the ability of education settings to deliver teaching and learning.[footnote 24]

In future pandemics, there may therefore be a benefit in restricting attendance in educational settings to priority groups in order to manage unmitigated transmission – not only to the broader population but also to children and younger people themselves who would experience health impacts and educational disruption from extremely widespread transmission.

This must be heavily caveated with the health and wellbeing impacts of limiting attendance in educational settings to priority groups – which are substantial.[footnote 25] They include:

  • missed learning
  • a reduction in non-COVID-19-related healthcare utilisation
  • exacerbation of existing inequality for both children and parents

Globally, full and partial school closures and restrictions on attendance have lasted an average of 224 days and affected more than 1.6 billion learners.[footnote 26]

Data in the UK has emerged on the mental health impacts of pandemic restrictions, including an observed 81% increase in the number of referrals to child and adolescent mental health services (CAMHS) and a 4-fold increase in demand for eating disorder treatment in the period April to September 2021 compared to the same period in 2019.[footnote 27] There is also evidence that pandemic restrictions impacted the behaviours of children and young people with evidence of poor and disrupted sleep, increases in screen time and reductions in physical activity. Additionally, the National Child Measurement Programme interim data collection in 2021 identified a substantial increase from 2020 in the prevalence of obesity in primary-aged pupils in England.[footnote 28] Survey data found a greater proportion of higher education students reporting dissatisfaction with their academic experience and limited opportunities for social or recreational activity.[footnote 29] For many children and young people, attendance at education and childcare is not only vital for learning but also for access to food and nutrition, physical activity opportunity, and health and therapy services. Restrictions on school attendance also gave rise to additional childcare and home-schooling responsibilities for parents and carers, leaving less time for work and leisure activities and impacting parental mental health. The long-term effects for children and families are not yet known.[footnote 30]

On the fourth consideration on the efficacy of mitigations, the evidence base has changed over time. Early decisions around the use of NPIs in education were largely based on modelling data or evidence from adult populations. With time, the challenges and opportunities of applying public health measures to a largely paediatric population became more apparent. Many of the NPIs that are effective in adult populations, such as social distancing and face coverings, are more difficult to implement in younger age groups and have differential impacts – for example, on social interactions.

Finally, rising immunity of the population through vaccines and prior infection has weakened the link between infection and severe disease. In March 2022, an estimated 99% of secondary school pupils and 82% of primary school pupils had SARS-CoV-2 antibody levels above the limit of detection.[footnote 31]

Summary of key measures taken in educational settings during this pandemic

In this pandemic, widespread attendance restrictions were implemented in the UK, and around the world, to reduce transmission of SARS-CoV-2. A number of other measures were also introduced including:

  • distancing
  • segmenting staff and students into ‘bubbles’
  • regular asymptomatic testing
  • wearing of face coverings
  • contact tracing and isolation
  • outbreak management and ventilation

Throughout the pandemic, schools stayed open for children of essential workers and for vulnerable children, enabled in no small part by the efforts of the teaching profession and other school staff, whose work meant that both remote and in-person education could take place. In many cases, and preceding formal restrictions on attendance in schools, parents removed their children from school settings in a response to potential transmission risks.[footnote 32] It was important throughout that parents were confident that measures in schools were both safe and proportionate. This is entirely understandable and will likely be the case in a future pandemic.

Initial response and limiting education setting attendance

Children and young people were initially assumed potentially to be effective transmitters of respiratory infections in general. Pandemic flu models, utilised to inform early advice during COVID-19, considered education and childcare settings as key contributors to spread.[footnote 33], [footnote 34] There was, however, significant debate about whether school closures or attendance restrictions would be needed for the initial wave in addition to other NPIs. Early discussions on the relative contribution of school closures to community transmission in the Scientific Advisory Group for Emergencies (SAGE) highlighted uncertainties around their impact and flagged that due to a relatively long serial interval for COVID-19, any closures would need to be longer than for previous epidemics to achieve the same impact on delaying the first wave or peak, with models suggesting closures of 8 to 12 weeks being required for maximum reduction of peak incidence.[footnote 35], [footnote 36] Debate centred on the role of schools in linking households, recognising that children and young people also mixed in other settings, and that the response of parents to any closures or attendance restrictions were a significant factor in their effectiveness. Early attention was given to the societal costs in terms of parental absenteeism and missed education.

In March 2020, the consensus SAGE view was that while school closures constituted one of the less effective single measures to reduce the epidemic peak, they may be necessary to manage NHS capacity.[footnote 37] The first attendance restrictions were initiated on 20 March 2020, just prior to national stay at home orders. Schools remained open for face-to-face learning for vulnerable children and the children of essential workers. At this time, the overall attendance of students who normally attend school in England was around 3% to 4% for primary school and 1% for secondary school children.[footnote 38]

The subsequent early signals from China were indicative of a mild clinical phenotype of COVID-19 in children and young people, with higher levels of less symptomatic infection. There was uncertainty regarding their role in transmission and the subsequent impact this may have on families, staff and communities. It was initially hoped that it would be possible to achieve a reproduction number (R) below 1 without school closures, but the speed of the initial wave and relatively high R0 made this uncertain with modelling implying it was unlikely that control would be achieved without school closures or attendance restrictions. Widespread attendance restrictions were therefore implemented during the first wave of COVID-19 in spring 2020, with face-to-face provision retained for vulnerable children and the children of essential workers throughout. Attendance restrictions in education occurred alongside widespread restrictions across wider society including a stay-at-home directive as part of a package. These measures were preceded by a level of behaviour change in the population that had already impacted on attendance and the ability of education settings to maintain staffing.

As the pandemic progressed, UK paediatric surveillance studies helped to monitor the course, progression and outcomes of COVID-19 in educational settings. Initial findings were suggestive of a low prevalence rate of COVID-19 infection in schools with the risk of outbreaks increasing as community incidence increased and limited transmission from child to teacher or vice versa, a lower secondary attack rate observed in schools compared to households, and low infection rates in school-based close contacts.[footnote 39], [footnote 40], [footnote 41], [footnote 42] Over time, the evidence strengthened to support a mild clinical phenotype for children and young people; however, PIMS-TS was seen in a small number of children requiring specialist care.[footnote 43] The long-term impacts of post-acute infection were poorly understood and there remains at the time of writing some uncertainty about the prevalence of long COVID in paediatric populations, though high-quality studies suggest this to be low.

Evidence of the likely wider impacts of widespread attendance restrictions were not immediately apparent, but in the first wave evidence also started to emerge of the harms associated with widespread attendance restrictions with lost learning, inequalities in the ability of children and young people to learn from home and a marked reduction in the number of child protection referrals being made.[footnote 44], [footnote 45], [footnote 46], [footnote 47]

Reopening with further measures

In August 2020, the 4 UK CMOs published a consensus statement which summarised the current evidence of risks and benefits to health from schools and childcare settings reopening.[footnote 48] The statement concluded it to be likely that opening schools to all would put some upward pressure on transmission more widely but that there was high confidence that schools were much less important in the transmission of COVID-19 than for influenza or some other respiratory infections.

All attendance restrictions were removed for educational settings in September 2020 with several public health measures in place to reduce contacts including social distancing, segmentation (‘bubbles’), and contact tracing and isolation.

Initially, close contacts in education were described in the same way as for adults and contact tracing conducted within settings. This led to high numbers of close contacts being identified for a single case in the early phases, and many staff and students experienced repeat bouts of isolation, impacting parents and carers’ ability to work with low-income families vulnerable to job losses.[footnote 49] As further evidence emerged on the relatively low attack rate within education settings, changes were made to contact tracing policy, including a shift of responsibility to NHS Test and Trace (England), use of ‘high and low risk contacts’ (Scotland, Wales and Northern Ireland), and a removal of the self-isolation recommendation for contacts under 18 years of age.[footnote 50] Education and childcare settings also segmented staff and students into smaller, consistent groups, or ‘bubbles’, to reduce transmission and aid in limiting the number of close contacts per case. There were also anecdotal reports of benefits to segmentation by reducing inter-year bullying, though we have not seen a formal measurement of this. Overall, the effective identification and isolation of cases and close contacts has been shown in this pandemic to be effective for reducing transmission in school and other settings – though with a need to adjust its application for educational settings.[footnote 51]

Settings were also advised to implement ‘social’ (physical) distancing measures such as spacing of desks within classrooms, closure of communal areas – for example, staff rooms – and one-way systems in corridors to reduce the number of contacts. Modelling studies have shown that reducing the number of contacts between students led to a reduction in the number of cases, with the magnitude of the effect dependent on the level of community transmission and susceptibility of individuals to infection.[footnote 52] School-based surveillance studies while segmentation was in place demonstrated a lower secondary attack rate observed in schools compared to households, and low infection rates in school-based close contacts.[footnote 53], [footnote 54] However, these measures were very difficult to implement and impacted the ability of the setting to deliver a full curriculum. Head teachers reported having to balance advice on social distancing and reducing close contacts with the ability for children to learn, especially in primary schools where reducing contact is more difficult.[footnote 55]

Building on strong existing local relationships, many local authorities provided intensive support to education settings throughout the pandemic for interpretation of guidance and outbreak management. In England a helpline was established by Public Health England and the Department for Education to provide public health advice, though local feedback highlighted that this did not always work in parallel with local systems.

Attendance restrictions during the second wave, mass asymptomatic testing and face coverings

In January 2021, attendance restrictions were once again implemented following the emergence of the Alpha variant which, ahead of widespread vaccine rollout, threatened high hospitalisation and death rates for adults. This was again accompanied by wider social restrictions including work from home directives and hospitality closures. Children were a higher proportion of those infected in this wave than the first wave.

At this time, it was well documented that children and young people were much less susceptible to severe clinical disease than older people.[footnote 56] In addition, there was clear evidence of the negative impacts of attendance restrictions for schools, including impacts on educational outcomes, mental health and physical health. It was acknowledged that measures with similar stringency and adherence to what had been in place in England in November 2020 (where schools were open) would be highly unlikely to be sufficient to maintain R below 1.[footnote 57] SAGE advice consistently highlighted that while the opening and closing of schools to the majority of pupils was likely to have an impact on transmission, policy decisions needed to balance the observed risks and harms.

Education settings were prioritised for re-opening in March 2021 and accompanied by mass testing policies. Routine lateral flow device (LFD) testing programmes for all staff and students of secondary age and above were implemented in all 4 nations in early 2021 (see Chapter 6: testing). The testing was a combination of onsite testing following return from a period of absence and regular home-based testing using LFDs to identify cases earlier on in the infectious period or that may not otherwise present.

Modelling studies have demonstrated the potential impact of mass testing and isolation on transmission in education settings – however, there is limited real-world data on their effectiveness, and uptake appeared to wane with time.[footnote 58], [footnote 59] The models suggest the impact is highest when testing coverage and the number of contacts identified is high.[footnote 60] Some barriers to uptake of the testing programme included concerns regarding the accuracy of the tests and perceived discomfort of undertaking the test.[footnote 61]

A school-based randomised controlled trial in summer 2021 showed serial testing of close contacts as non-inferior to isolation for transmission. Serial testing was later introduced as national policy to reduce disruption.[footnote 62]

Face coverings were first recommended in education settings on return in March 2021 following evidence supporting their use in community settings to reduce COVID-19 through source control, wearer protection and universal masking.[footnote 63] Policies have varied with time and included use in communal areas, classrooms and on school transport. They have primarily focused on all staff and students of secondary age and above, and face coverings for under 11s have not been proactively recommended, nor face covering type mandated.

An association between face covering use and decreased COVID-19 incidence in children is shown in 10 studies, and the World Health Organization (WHO) conclude that evidence from adults and community settings can also be extrapolated to children and young people. However, the evidence is generally of poor quality. Other, quasi-experimental studies have demonstrated null effects, with age-dependency being a higher risk factor for COVID transmission risk.[footnote 64] Experimental analyses from the Department for Education suggested a reduction in COVID-19-related absence in secondary schools that introduced a face covering recommendation compared to those that did not. The difference was statistically significant, however the study made a number of assumptions and causality cannot be determined.[footnote 65] Therefore findings should be interpreted with caution.

The use of face coverings in education settings has had to balance the potential impact on transmission with impacts on communication and learning. Survey data from Scotland reported concerns with understanding when face coverings were worn and a survey of teachers and secondary school leaders in England found 94% think wearing face coverings had made communication between teachers and students more difficult.[footnote 66], [footnote 67] There are also likely greater impacts on children with special educational needs and disabilities, existing speech, language and communication issues or those who have hearing loss or auditory problems.[footnote 68] Overall, panel surveys indicate that it was the cumulative impact of COVID-19 mitigations, including face coverings, that had an impact on pupil wellbeing, and many staff found strategies to minimise disruption.[footnote 69]

Reopening, continued mass asymptomatic testing, outbreak management and ventilation

By late 2021, the availability of vaccines and effective therapeutics reduced the link between cases and hospitalisations and deaths in more vulnerable groups, and this reduced the need for such intensive measures to manage transmission to be taken. In summer 2021 many of the more restrictive public health measures such as social distancing were removed from education, in line with wider society and the UK government roadmap.[footnote 70] Education policy therefore focused on asymptomatic testing, outbreak management (including face coverings) and ventilation. Attendance restrictions for education were ultimately considered a last resort.

Improving ventilation is an important factor in mitigating against risk of airborne transmission of COVID-19, with greater benefit seen in occupied spaces with poor ventilation.[footnote 71] Education and childcare settings have been encouraged to ensure good ventilation as a baseline infection prevention and control measure and the 4 nations introduced different policies to provide carbon dioxide monitors to the education sector to support the detection of areas of poor ventilation. In England, a survey suggested that only 12% of education settings using carbon dioxide monitors reported identification of spaces with sustained high carbon dioxide readings, and of these only 3% were unable to remedy through quick fixes or remedial building works.[footnote 72]

High efficiency particulate air (HEPA) filter devices are a type of air cleaning device designed to filter pollutants or contaminants out of the air that passes through them, and although not a substitute for good ventilation, may be of benefit in areas of poor ventilation where it is not possible for ventilation to be improved through other means such as opening windows. Evidence of the effectiveness of air cleaning devices in school settings is still being collated but, so far, the observed reduction in risk is modest compared to other interventions.[footnote 73] A widely reported study from Italy suggested ventilation could reduce the transmission of COVID-19 in schools by more than 80%. However, the paper has not yet undergone peer review.[footnote 74] A randomised control trial is underway in Bradford to help answer questions around feasibility and impact of air filtration devices in primary schools.[footnote 75] There is also differing evidence on the impact of good ventilation on other health measures such as cognitive performance.[footnote 76], [footnote 77] To be effective, many classrooms would require more than one air filtration device and they can be noisy.[footnote 78]

Asymptomatic testing was continued, though the balance of benefit in detecting asymptomatic cases to reduce transmission and harm (in taking repeat tests and in missing school by isolating asymptomatic cases) changed throughout the pandemic as vaccines and therapeutics became available.[footnote 79] Children and young people attending education have been one of the most heavily tested groups throughout the pandemic despite the low risk of clinical harm. Testing can be unpleasant for some and not well tolerated by some groups with additional needs. Alternatives to swab-based testing such as saliva-based approaches were explored but not universally implemented. In autumn 2021, the emergence of more transmissible variants led to a surge in cases and onward household transmission in the school-aged population, suggesting that asymptomatic testing alone was not sufficient to control transmission.[footnote 80] Asymptomatic test policies had been removed from the majority of education settings by Easter 2022.

Vaccination

There was considerable debate on the place of vaccination in children and its relative importance to reduce educational disruption in addition to health benefits. The UK CMOs were asked to advise on the universal vaccination programme for children and young people aged 12 to 15 years, and to avoid duplication a link to their published advice is in Appendix A: some key UK CMO joint statements during COVID-19. We therefore do not replicate it here. It is worth reiterating here, however, that decisions were made on the basis of risks and benefits in children, and did not take account of any impact on wider society.

Further and higher education

The further and higher education sectors in the UK are very varied, providing a range of educational opportunities to all ages, including adults, and offering varying learning types that include online approaches, apprenticeships and courses requiring face-to-face learning such as medicine or nursing. The sectors also cover settings of different sizes and in different locations: from large universities in large cities catering for over 40,000 students to smaller further education colleges in smaller towns. Most, but not all, of the sectors offer residential accommodation and ordinarily students in higher education travel from around the world to attend.

In March 2020 university and college campuses were closed and teaching moved online, reopening for face-to-face provision in autumn 2020. The risk of this reopening amplifying local and national transmission was highlighted in SAGE meetings in September 2020, with guidance provided to the sector on how to mitigate this risk.[footnote 81] There was a rapid rise in cases of COVID-19 in 17 to 21 year olds following the start of the academic year. However, the trend was not uniform across universities or local areas. In the early phase of the pandemic, several settings undertook studies of transmission dynamics and were able to demonstrate that at the time the bulk of transmission that occurred between students was taking place within residential spaces, with minimal evidence of transmission within learning environments or to the wider community.[footnote 82]

Key interventions utilised in the higher education sector were contact tracing and isolation, cluster identification and outbreak management, wider quarantine across settings, and use of other NPIs such as face coverings. Mass testing was implemented for higher education students returning home for Christmas in December 2020 to reduce household transmission risks as they returned to their households. The bulk of teaching returned online for the second period of national lockdown in winter 2020 to 2021, with face-to-face education reopening for most settings in May 2021 with mass testing programmes and other NPIs in place. Some universities chose to implement their own policies such as requiring negative test results for access to social events.[footnote 83]

While there remain a small number of settings that have not yet returned to face-to-face teaching, higher and further education students and staff went to great efforts to mitigate the risk of transmission into the wider community, enduring prolonged isolation and quarantine rules – for many students this was during their first experience of being away from home. Several studies have since highlighted the impact of these experiences on mental health with more than half of students reporting their wellbeing and mental health had worsened as a result of the pandemic.[footnote 84]

Reflections and advice for a future CMO or GCSA

Point 1

NPIs in educational settings have the potential to have lasting effects on children’s education, developmental and life chances.

To strike the right balance between health and educational impacts, it is important therefore with any new pathogen to understand as soon as possible the clinical risk to younger age groups (as well as staff and families) and the role that educational settings play in transmission. The latter proved particularly difficult and contentious with COVID-19.

Point 2

Educational settings should not be seen in isolation.

Transmission of COVID-19 in education and childcare settings, for example, was strongly correlated with transmission in the wider community, and public health interventions that reduce community levels of transmission will help minimise ingress into these settings.

Point 3

NPIs in education can exacerbate problems of inequality and deprivation.

Education and childcare settings in more deprived areas were often in areas of enduring transmission and were also more likely to struggle to implement NPIs due to resource or capacity limits. Similarly, effective home education was influenced by access to digital resources such as computers and wifi, and parents’ ability to work from home.

Point 4

The education and childcare sector and the educational estate should not be seen as a single block.

Early years settings or support for those with special educational needs have faced additional challenges implementing public health interventions like distancing. No two schools are the same in terms of how best to implement, for example, ventilation and air filtration. These are important considerations for the provision of guidance to the sector.

Point 5

The difficulties of real-world evaluation of NPIs in educational settings should be anticipated.

Children and young people do not behave or respond in the same way as adults and while there can be valuable extrapolation, it is important that research takes account of these differences.

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