How has the return to schools affected COVID-19 cases in the UK?
With children across the UK returning to schools, there have been increased cases of COVID-19 schoolchildren according to data from the Office for National Statistics
The latest coronavirus infection survey from the Office for National Statistics (2021) was released on 26 March, with the next report due on 1 April. The analyses of COVID-19 cases in particular age groups are reported separately for England, Wales, Scotland and Northern Ireland. In light of children having returned to school, many were concerned about the effect this may have on cases of coronavirus.
In England, children returned to school from 8 March and the latest attendance data show that on 25 March, 90% of students were attending school, down from 91% the week before (Gov.uk, 2021). Estimates for the percentage of the population testing positive for coronavirus on a daily basis have begun to increase for those age 2 years old up to school year 11. Cases were decreasing across these age groups between 7 and 17 February, but the most recent data up to 20 March show that case numbers began to level off, and then increase in this later period. It should be noted that these data are based on infections reported in the community, and do not include infections reported in hospitals, or other institutional settings.
In Wales, estimates of the percentage of children between 1 and 10 years old testing positive for coronavirus fell between 9 February and 17 March 2021 (Gov.wales, 2021a). School children in Wales began a phased reintroduction to school from 22 February, with the goal being to return all children to school after Easter (Gov.wales, 2021b).
In Scotland, all primary school children returned to school on or before 15 March, with all pupils expected to return to face-to-face teaching after Easter (Gov.scot, 2021a). The daily estimate of the percentage of the population testing positive for coronavirus has shown an increase since the end of March for those aged 5, 10 and 15 years old. (Gov.scot, 2021b).
In Northern Ireland, as of 22 March, children up to primary seven and students in years 12 to 14 were back in school, and students in years 8 to 11 are currently predicted to return to school on April 12 (NI direct, 2021). Estimates in Northern Ireland for the percentage of people 7 years old and 14 years old testing positive for COVID-19 show an overall decrease between the start of February and 20 March (Department of Health, 2021). However, it should be noted that there is very high uncertainty around these trends, which the publication notes is a result of the relatively small number of people included in the analysis (Department of Health, 2021).
Prime Minister, Boris Johnson commented on March 29 that the slight increase in cases being seen among young people, especially those of school age, is ‘almost certainly because of the opening of schools again’. He went on to say that because young people are set to be vaccinated later in the rollout of the COVID-19 vaccine, it is ‘inevitable’ that cases in this group will rise, but that ‘it’s so vital that we do what we're doing right now…continuing to fortify the population, roll out the vaccine at the speed that we are. The government's aim is for all adults to have received the vaccine by the end of July.
Initial results from the Pfizer vaccine trial in children aged 12–15 years old show 100% efficacy and a strong immune response (BBC News, 2021). Astrazeneca has also begun testing the response to their vaccine in children aged 6–17 years old in the UK. However, currently the COVID-19 vaccines are not authorised for use in children, and the data for the Pfizer vaccine are preliminary results that have not been peer-reviewed or published in a journal.
‘In light of children having returned to school, many were concerned about the effect this may have on cases of coronavirus’
Government announces £500 million mental health recovery plan
The COVID-19 pandemic has led to an increase in mental health issues across the UK. The government has now announced the budget for an action plan to address these issues
The government has announced a £500 million action plan to support people with mental health issues, which aims to tackle the effects of the pandemic on the mental health of the UK population (Department of Health and Social Care, 2021). The plan was published on the 27th of March as part of the government spending review.
Nadine Dorries, the minister for mental health and suicide prevention, said the public had shown ‘great resilience’ in the face of the pandemic, ‘but some groups including young people and those with severe mental illness have been impacted more than others. This funding will support these groups, both in initiatives specifically designed in the wake of the pandemic, and by enabling us to bring forward our NHS Long Term Plan commitments' (Department of Health and Social Care, 2021).
Research has shown that mental health issues among young people have become more prevalent across the UK during the pandemic. The need for social distancing and advice from the government to ‘stay at home’ has meant that opportunities for activities known to help mental health, such as face-to-face social interaction and exercise, have been limited.
For young people, the difficulties of the pandemic have been combined with the halt of most of their usual extracurricular activities and the move to remote learning during school closures. These factors are likely to have a significant impact on young people, and research has shown that mental health issues in adolescence have a lasting effect into adulthood (World Health Organization, 2020). The consequences of leaving these issues unaddressed in young people can impair physical and mental health in later life (World Health Organization, 2020).
In February this year, YoungMinds, a charity aimed at tackling mental health issues in young people, released the results of a survey of over 2 500 13–25-year-olds. Overall, 67% of respondents reported they felt that the pandemic would have a long-term effect on their mental health (YoungMinds, 2021).
Similarly, research reported by Mind has shown a sharp rise in cases of mental health issues over the course of the COVID-19 pandemic, including ‘significant increases in mental health problems among young people’ (Mind, 2021). The chief executive of the mental health charity Mind, Paul Farmer, welcomed the announcement of the mental health action plan, commenting that ‘this money can't come soon enough’ (Mind, 2021).
Overall, £79 million of the total budget for the Mental Health Recovery Action Plan will be put into areas involving children and young people, including mental health support teams, eating disorder services and community support. The plan includes funding for pilot approaches to support children who have experienced complex trauma in light of the pandemic and also focuses on supporting learning disability and autism services, as children and young people with these conditions may have been more affected by the crisis of the past year.
How to talk to children about death and grief
The COVID-19 pandemic has meant children may be more likely to experience bereavement. A number of organisations have released advice on talking to children about coping with grief
As of 31 March 2021, the COVID-19 pandemic has led to almost 150 000 deaths in the UK (Public Health England, 2021). As a result, children may have experienced the death of a family member or someone else in their life.
Barnardo's, a UK charity dedicated to improving the lives of vulnerable children, has released their guidance for parents on how to talk to children about death and grief (Barnardo's, 2021). The advice focuses on how to explain what has happened in a way that allows the child to understand the concept of death, and on being open and honest when having this discussion with a child.
The seven tips released by Barnardo's (2021) are:
- Be open and honest
- How to explain death to a child
- Explain how a person died
- Help them to understand the concept of death
- Help them understand it is not their fault
- Help them to say goodbye
- Take care of yourself.
Barnardo's advice notes that while it is natural to want to shield children from difficult discussions, such as those surrounding death and bereavement, providing ‘clear, age-appropriate, honest information’ is the best way to handle the situation. It also highlights that it is common for children to blame themselves in these situations, and that it is important to emphasise that this is not the case.
The final point in the Barnardo's list of tips is to ‘take care of yourself’. This tip highlights that while it is important to take care of a child in this situation, it is equally key for parents to ‘take time to care for yourself’ as this will help both the parent and child in the longer term.
Marie Curie (2021) has also recently published advice focusing on talking to children about death. The advice focuses on similar points, highlighting the importance of being honest, providing reassurance and using plain language to avoid miscommunication. They note that euphemisms, such as that someone has ‘gone to sleep’ or that they have ‘gone away’, are often unhelpful, as they may cause the child to experience anxiety when family members leave the house or when they go to sleep.
Children in England and Wales have recently returned to school, and those in Scotland are set to go back after Easter (Gov.wales, 2021; Gov.scot, 2021). Schools are likely to have a number of pupils who have experienced a loss during the coronavirus pandemic.
The most recent back to school support packs by the PSHE Association (2021a, b) for key stages 1–2 and 3–5 do not recommend that lessons on bereavement are taught in schools at the current time. Although the subject of bereavement is included within PSHE education, the PSHE Association advises that these lessons are intended to help children and young people with situations that they are not immediately experiencing, and that they focus on how to manage such situations if they arise in future. The association notes that students are likely to be emotional if they have experienced a recent loss, and teaching on the subject of bereavement could ‘add to anxiety among the school community’ (PSHE Association, 2021b).
Child Bereavement UK (2020) has published guidance on supporting bereaved pupils, which focuses on the role of schools during a time when grief is both more common and may be harder to cope with as a result of social distancing measures.
‘…it is natural to want to shield children from difficult discussions, such as those surrounding death and bereavement…providing “clear, age-appropriate, honest information” is the best way to handle the situation’
Cancer survival in young people has improved for most cancers
The first UK-wide report on cancer in children and young people in almost 10 years has been published by Public Health England in collaboration with UK national cancer registries
A collaborative work on cancer in young people has been published by Public Health England alongside UK national cancer registries from Scotland, Wales and Northern Ireland (Irvine, 2021). The report combines data on incidence, survival and mortality rates from across the UK.
Ben Sundell, head of policy for the Teenage Cancer Trust, said that the trust ‘welcome[s] the insight this report provides in helping us understand the progress that has been made in cancer care across the UK’ but noted that the COVID-19 pandemic had ‘increased pressure on healthcare providers across the UK’ and it was vital that young people were not forgotten, as ‘no young person should have to face cancer alone’ (Teenage Cancer Trust, 2021).
The report shows that over 3 500 young people between 0 and 24 years old are diagnosed with cancer in the UK every year, and is more common in males. Approximately 1 in 420 boys under 15 years old develop cancer, in comparison to 1 in every 490 girls in the same age group.
The most common cancers diagnosed in children between 0 and 14 years old in the UK are leukaemia (accounting for 31% of cancers in this age group), followed by brain and spinal cord cancer (25%) and lymphoma (10%). In young people aged 15–24 years old, the most common cancers are lymphoma (20%), germ cell tumours (16%) and skin cancer (15%).
There are teams across the UK that focus on specific forms of cancer in children, particularly leukaemia, because of its high prevalence. Associate Professor Anindita Roy and Professor Anastasios Karadimitris at Imperial College London are currently focusing on developing novel targeted immunotherapy for childhood acute lymphoblastic leukaemia (Cancer Research UK, 2021a). Similarly, a team based at University College London are focusing on analysing nationwide samples of children and young people with leukaemia to target cases of relapse in children. The team includes Dr David O'Connor, Dr Marc Mansour, Dr Jack Bartram and Professor Owen Williams at University College London, who are partnered with Great Ormond Street Hospital. They are looking to identify biomarkers of the disease in children, to allow for more targeted treatments in cases of relapse (Cancer Research UK, 2021a).
One of the key results of the statistics report released earlier this year is that the cancer survival rates in children and young people have improved for most cancers. The 5-year survival rate in young people aged 0–24 years old for various cancers was computed, comparing the rates for people diagnosed in 1997–2001 and people diagnosed in 2012–2016. The survival rate for young people with lymphoid leukaemia rose from 78% to 89% between these two time periods, and the survival rate for non-Hodgkin's lymphoma rose from 76% to 87%. Smaller increases in survival rate were seen in other cancers in young children, but these were mostly in cancers where the survival rate was already over 90% (Irvine, 2021).
The COVID-19 pandemic will undoubtedly have had an effect on people across the UK who have or are suspected of having cancer. An early study by Cancer Research UK (2021b) and Cardiff University found that in the first wave of the pandemic, nearly half (45%) of people with potential cancer symptoms did not contact their GP. This was based on a survey of over 7 500 people between March and August 2020 and participants reported that they did not contact their GP because they did not want to burden the NHS during such a difficult time, among other reasons.
‘…as a result [of the cancer backlog]…we're likely to see more patients diagnosed at a later stage when chances of survival are lower, likely stalling or even reversing improvements in cancer survival’
The charity Children with Cancer UK (2021) recently published a statement urging governments and NHS leaders across the UK to direct efforts to clearing the cancer backlog, encouraging people to seek help from their GP if they have signs and symptoms of cancer, and expand the number of key staff in cancer professions, among other goals. They report that approximately 40 000 people in the UK who should have started cancer treatment in 2020, but were unable to as a result of the pandemic, and state that it ‘will take months if not years to clear the cancer “backlog”…as a result, sadly, we're likely to see more patients diagnosed at a later stage when chances of survival are lower, likely stalling or even reversing improvements in cancer survival’.
As well as the Children with Cancer UK charity, the statement was signed by a total of 47 cancer charities. The charities are hoping that this push will encourage a move not only to handle the issues caused by the COVID-19 pandemic, but also to improve cancer services generally across the UK. They are calling for investment to encourage earlier and faster diagnoses, as well as services to personalise care and support for all cancer patients and strengthen UK research and development through commitments to multi-year funding in medical research and embedding research in healthcare settings.
A key element of this statement is to target inequalities in cancer outcomes, as they note that there are more than 20 000 more cases of cancer each year in more deprived areas of the UK. The charities are calling for robust data evaluation to inform targeted interventions to reach groups that are more widely affected by cancer.
Though it is encouraging that cancer survival rates in young people are improving, it is vital that the impact of the COVID-19 pandemic is handled efficiently and effectively by UK policies when looking at improving cancer services.
Plans to tackle cases of sexual abuse in schools
The Department for Education has announced plans to tackle issues of sexual abuse in schools. Education Secretary, Gavin Williamson, announced on 31 March that two key actions are being put in place to address these issues. A new helpline has been established by the National Society for the Prevention of Cruelty to Children (Department for Education and Williamson, 2021). This helpline will be dedicated to providing children and adults with appropriate support and advice, if they feel they are at risk of or have experienced sexual abuse, including how to contact the police and report crimes if they wish to. This helpline went live on 1 April.
The announcement also laid out the government's plans for an Ofsted review of school safeguarding policies in relation to sexual abuse.
Last year, the Everyone's Invited movement was set up, to allow people to anonymously share their experiences of sexual violence and abuse (Everyone's Invited, 2020). A large number of these testimonies involved cases of unreported sexual violence within schools and between children of school age, including some from children as young as 9 years old. In response, Everyone's Invited have now also launched a campaign inviting pupils and ex-pupils to write to their schools, to share stories of sexual abuse in relation to the school and to urge schools to reform sex education and develop zero tolerance policies towards sexual violence and abuse (Everyone's Invited, 2021).
Gavin Williamson responded to the outpouring of anonymous testimonials relating to sexual abuse in schools, saying that ‘sexual abuse in any form is abhorrent’ and committing to ‘mak[ing] sure the right resources and processes are in place across the education system to support any victims of abuse to come forward’.
The Ofsted review will involve representatives from social care, victim support groups, school and college leaders, and the Independent School Council, as well as the police. It is currently set to be completed by the end of May 2021. Its focus will be on establishing the extent and severity of the issue of sexual abuse in schools and ensuring schools have appropriate methods in place to deal with students reporting their concerns and then handling those concerns. If the findings show that schools are not meeting safeguarding standards, the Department for Education will take action to improve the situation, ensuring schools either improve their practices and policies, or are closed.