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Factfind: What advice did NPHET give to Government around the closure of schools?

Debate about the safety of schools in relation to Covid-19 is ongoing.

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THE ONGOING DEBATE about the aborted re-opening of schools for pupils with special needs has seen sharp exchanges between teachers’ unions and ministers this week.

Plans for special education classes to return today were scrapped on Tuesday after Fórsa and the Irish National Teachers Organisation (INTO) publicly opposed such a move.

Education Minister Norma Foley accused the unions of being unable to “accept the expert public health advice”, after they raised doubts about whether a return to schools would be safe for special needs teachers and assistants.

The minister has repeatedly claimed that the National Public Health Emergency Team (NPHET) insisted schools were safe, and asked for them not to stay open out of concern about the interaction between 1.1 million people travelling to and from school each day.

For the purposes of this factfind, we’re going to look at this claim, and what was said by both the minister and NPHET in its recommendations.

This factfind will not make any conclusions on whether the right decision was made, or the impact that different decisions would have had.

Department of Health 010 Dr Tony Holohan. Source: RollingNews.ie

Firstly, we’ll look at the measures the government brought in to close schools this month.

Then we’ll look at claims made by Foley in two radio interviews, one last week on Newstalk Breakfast and one the week before on RTÉ Radio 1′s Drivetime.

And finally, we’ll look at exactly what NPHET recommended and their reasons for doing so, and compare it with what the minister said. 

Closure of schools

On December 30, Micheál Martin announced that schools across the country would delay their post-Christmas re-opening by five days in response to a rapidly increasing number of cases of Covid-19 across the country.

In an address to the nation, Martin said that evidence showed the government that schools – which had been due to re-open on 6 January – were safe places.

“All public health analysis is showing that schools are safe, and schools will reopen, but slightly delayed to 11 January,” the Taoiseach said.

With case numbers still rising on 6 January, Martin announced that primary and secondary schools would remain closed until at least February.

There were to be two exemptions to this. The government initially said that special education should remain open with protections in place, and that Leaving Cert students would be allowed to attend classes for three days per week – both from 11 January.

However, these exemptions were done away with after both primary and secondary teachers’ unions opposed the plans.

NO FEE TAOISEACH EXIT LEVEL 5 JB4 (2) Micheál Martin at Government Buildings Source: RollingNews.ie

This second announcement by the Taoiseach followed a specific recommendation by NPHET that keeping schools open would risk worsening the Covid-19 situation in Ireland in the context of case numbers at the time.

“Opening schools means that a million people are out there in the community,” Martin told RTÉ News on the evening of 5 January.

“And given the rapidity and the spread of the disease, and given what we’re witnessing elsewhere in other jurisdictions, in terms of that rapidity, and that growth, one has to really measure the advisability of doing that.

“That’s why it is on the agenda today that we would extend out the closure of schools to the end of the month.”

Radio interviews

The following day, Minister Norma Foley was interviewed by Sarah McInerney on RTÉ Radio 1′s Drivetime programme.

During the interview, the minister was asked three times whether the government had sought any specific advice from NPHET to allow Leaving Certificate students to return for three days a week from 11 January.

In each instance, she mentioned the letter from Chief Medical Officer Dr Tony Holohan to Minister for Health Stephen Donnelly sent on 5 January, outlining NPHET’s advice about schools.

In her first response, Foley said: “[Holohan] specifically states in his letter that any recommendation in terms of the schools is not in any way based on a changed assessment of the risks in relation to transmission levels in schools.

“It has nothing to do with how schools are operated and how they’ve been operating successfully in the last number of months.”

McInerney then put the question about Leaving Certificate students to the minister a second time.

Foley responded that “the advice was a general recommendation[...] from the CMO in relation to the need to reduce mobility in the community”.

The minister was then asked about Leaving Certificate students a third time.

She said: “At no stage did the CMO or NPHET indicate at any point that schools were unsafe. They made a general observation about mobility of people within the community and the need to reduce mobility in all sectors of society.”

NO FEE TAOISEACH PRESS CONF GOV BUILDINGS JB12 Norma Foley Source: RollingNews.ie

The next day, plans for Leaving Cert students to attend schools for three days a week were abandoned

The move came after the Association of Secondary Teachers in Ireland and the Teachers Union of Ireland directed members not to co-operate with the Government’s plan.

The unions said they had not been provided with assurances that schools were safe for students and teachers, particularly in the context of a new variant of Covid-19 circulating in the community and high numbers of new cases.

The following week, Foley appeared on Newstalk Breakfast after the government announced that classes for children with special needs would return from 21 January.

Asked again if other students would return on 1 February, Foley re-iterated the claim.

“Given the current situation in society… society needs to hunker down as it were, to reduce its mobility, reduce its contacts,” she said.

“And for that reason, there was a view that the full reopening of our schools would be problematic, in that there was too many people moving around.

“But equally so, in making that determination, the CMO and NPHET were very clear to say that there is no issue with regards to safety in schools, they have not changed their minds as regards to the school environment as a safe environment.

“It was only being stood down in terms of reducing mobility.”

NPHET advice

So what did the National Public Health Emergency Team actually say?

On 30 December and 5 January, NPHET sent letters to the Health Minister recommending the introduction of new public health measures (which you can read in full here).

In the December letter, the Chief Medical Officer told the minister that health officials had given specific consideration to the reopening of schools after Christmas.

Dr Tony Holohan said that it was NPHET’s view at that point that “schools should reopen as planned” despite a sharp rise in Covid-19 case numbers in previous days.

He explained that this advice was based on an assessment that the known negative impacts of school closures on children (such as mental health and development) outweighed the potential risks to children and staff from Covid-19.

However, he noted specifically that if “high and rising levels of community transmission” continued, it would risk the provision of education in primary and secondary schools.

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NPHETschools1 Source: Department of Health

Almost a week later on 5 January, Holohan wrote to the Minister for Health again to warn about the consequences of keeping schools across the country open.

He stated that there had been a further deterioration “across all indicators of disease transmission and severity in the six days since NPHET last met”.

The CMO said:

The current epidemiological situation has deteriorated to a point where the significant levels of mobility and linked activity that the full reopening of schools would generate, constitutes a very significant additional risk in the context of what are already unprecedented levels of disease transmission in the community.

“It is important to state that this advice is not based on a changed assessment of the risks in relation to transmission levels in schools.

“Rather, it is a reflection of the overall epidemiological situation and the absolute need now to reduce all opportunities for transmission.”

Throughout his letter, Holohan also referred to other factors which had emerged since NPHET’s previous recommendations.

He told Stephen Donnelly that despite new measures being introduced in late December, Ireland’s epidemiological situation was likely to worsen.

He repeated concerns about the potential for the provision of education to be impacted by high community transmission if schools remained open.

And he raised concerns about the new highly transmissible UK variant of Covid-19.

Holohan confirmed that the strain had been detected in Ireland on Christmas Day, and sampling later showed that one in four positive Covid-19 cases in Ireland that week were down to the UK variant. 

In his letter to the government on 30 December, the CMO suggested that the circulation of the novel strain in the UK in November – while schools were open – could have contributed to a rise in cases of the virus among under 20s.

As a result he suggested that keeping schools open in Ireland would be unlikely to reduce to R number to below 1 (whereby each person on average would pass the virus on to less than one person).

“R would be lower with schools closed, with closure of secondary schools likely to have a greater effect than closure of primary schools,” Holohan wrote.

“But it is also stated that it is not known whether measures with similar stringency and adherence as spring, with both primary and secondary schools closed, would be sufficient to bring R below 1 in the presence of the new variant.”

He highlighted a preliminary study by Imperial College London which suggested that people under the age of 20 could be more affected by the new variant.

Holohan explained that this could be down to a number of factors – including transmission “during a time when lockdown was in force but schools were open”.

Imperial College Source: Department of Health

Meanwhile, he also pointed to some international evidence which suggested that the closure of schools could achieve a reduction in viral transmission and reproduction number across the population as a whole.

However, he added that it was not known why this happened.

“It is not clear to what extent this might be due to the elimination of the opportunity for the virus to transmit in the school setting, or due to decreased mobility of and social mixing between adults because of school closure, or a combination of both,” he said.

The CMO further stressed that school environments were relatively safe, saying it was clear from data available to NPHET that there is “very little evidence of transmission in schools”.

“There have been relatively few outbreaks in schools, and relatively few cases associated with those outbreaks[...] the vast majority of cases in children and adolescents occur outside the school setting,” Holohan said.

Concluding his letter, he also noted that specific measures should be taken “to ensure that more vulnerable children can best be supported” in the coming weeks, but he did not specify what form of support should be provided.

Schools close Source: Department of Health

Analysis

Firstly, it is true that NPHET advised the government that there would be higher rates of community transmission in Ireland if schools remained open.

Dr Tony Holohan also emphasised that the risk of Covid-19 transmission in schools had not changed significantly, despite higher rates of transmission across the country.

The CMO did point to international evidence that the closure of schools could reduce levels of community transmission generally – although he said it was not known why.

He said this could possibly be because the virus had fewer opportunities to transmit in school settings, because of decreased mobility among and social mixing between adults, or because of a combination of both factors.

In a passing reference to the UK variant, he also highlighted a study which stated that the new strain could potentially affect under 20s more because schools in the UK were open as the strain was emerging there, despite a national lockdown being in place at the time.

In Foley’s comments to RTÉ Radio, she stated that NPHET had advised that if schools remained open, the widespread transmission of Covid-19 could continue through “mobility” (i.e. people travelling to and from educational settings).

She said:

The advice was a general recommendation[...] from the CMO in relation to the need to reduce mobility in the community.

In the minister’s remarks to Newstalk the following week, she said this was the only factor.

Said Foley:

[The re-opening of schools] was only being stood down in terms of reducing mobility.

NPHET’s final recommendation on 5 January was that “significant levels of mobility and linked activity” associated with a full re-opening of schools would pose significant risks while Ireland was experiencing high levels of Covid-19 transmission in the community.

The CMO also re-iterated that “schools are in themselves a safe environment”.

In summary, Dr Holohan told the government that mobility associated with a full return to schools was the primary factor behind its recommendation not to do so.

The CMO also made references to the fact that the R number and general levels of community transmission could be reduced if this happened, although he suggested that this may not primarily be linked to school closures.

Despite stressing that classrooms were safe, he did highlight the possibility that keeping schools open could lead to higher levels of the new UK variant of Covid-19 among under 20s.

He further suggested that closing schools might eliminate the possibility for the virus to spread in them, a logical conclusion, given that closing schools would mean nobody could enter classrooms to pass the virus on to each other.

When he outlined NPHET’s position on whether to keep schools open at the conclusion of his letter, he did not restate the factors he had outlined earlier in his text, suggesting that other steps may be taken to address the wider spread of Covid-19.

“NPHET will meet as usual this Thursday 7 January and will give consideration to any further measures which may be required to address the current levels of community transmission and its consequences,” he said.

“As always, I would be happy to discuss further, should you wish.”

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