Health officials defend end of close contact tracing in schools and creches

Health officials defend end of close contact tracing in schools and creches

Chair of the NPHET Irish Epidemiological Modelling Advisory Group, Professor Philip Nolan. File Picture: Gareth Chaney/Collins

The re-opening of schools at the end of last month has not resulted in a significant increase in Covid-19 transmission, the chair of the National Public Health Emergency Team's (Nphet) Epidemiological Modelling Advisory Group has said.

In a Twitter thread, Professor Philip Nolan defended health officials' decision to allow asymptomatic close contacts of Covid-19 cases to continue to attend school.

He said that while the level of infection in children and adolescents increased over the course of this past summer, largely as a result of the more-transmissible delta variant, this had now "stabilised at a high level in children aged 12 and under” and has decreased markedly" among those aged between 13 and 18.

Prof Nolan said that vaccinations have reduced incidence rates in adults and adolescents and have started to lower the probability of children become infected with Covid-19.

"When schools reopened it was inevitable that some children attending school would subsequently develop symptoms or test positive. It was prudent at that time, with limited experience of the delta variant in schools, to isolate and test their contacts,” he said.

On Wednesday, officials from the Department of Health confirmed that close contact tracing and testing measures in creches and primary schools will be discontinued from next Monday.

From then, automatic contact tracing of close contacts in childcare facilities and primary education will cease, not including special education facilities.

The testing of asymptomatic close contacts in childcare facilities and primary education will be also be halted, not including special education facilities.

Under the changes:

  • Children aged 12 or under, identified as close contacts in childcare, educational settings, or other non-household settings and who are asymptomatic will no longer be required to restrict movements unless indicated by the local public health team.
  • Children aged 12 or under who are identified as household close contacts in household settings will still be required to restrict movements and get tested, regardless of symptomatic status.
  • Cases and outbreaks in Special Educational Needs (SEN) settings, respite care, or residential settings will still require a public health risk assessment.

The changes were signed-off by Health Minister Stephen Donnelly, following discussions with Nphet and the chief medical officer.

In response, the country's largest teachers' union has called for a deferral until after the mid-term break.

The Irish National Teacher's Organisation (INTO) said that abandoning the current contact tracing arrangements could cause “mass confusion” for schools, principals, staff, and parents.

The union said a deferral would "allow time for better data to be obtained and sufficient time for considered analysis and to allow for the proposed changes to be implemented in an orderly fashion."

Prof Nolan did acknowledge that reopening of schools did indeed lead to a “three to four-fold increase in the number of children being referred for Covid testing".

However, he said that the yield from this additional testing was low. 

"This pattern is typical of increased case ascertainment due to intensive testing, that is, a very large increase in testing is finding (largely asymptomatic) cases that we were not detecting before, rather than a true increase in the underlying level of infection," he said.

Prof Nolan said his data supports health officials' experience last year that schools "are not major contributors to or drivers of transmission".

"The resumption of in-person education has not been associated with a significant increase in the level of infection when increased testing is taken into account.

The President of Maynooth University said that the risk associated with allowing an asymptomatic in-school contact to continue schooling is low compared with the impact of excluding that child from school.

"The most important intervention now to keep schools and children safe is to support parents and guardians in keeping children with symptoms suggestive of SARS-CoV-2 home from school and caring for them," he added.

HSE clinical lead for children: 'Well' children are 'not drivers of infection'

Dr Abigail Collins, the HSE clinical lead on child health, defended the changes this morning.

Speaking on Morning Ireland, she said that health officials were "constantly evaluating if what they were doing was necessary and proportionate". 

She said that "well" children were "not drivers of infection, and not very good at spreading the infection if they have no symptoms".

"The balance of the benefits and the harms of excluding well children from society, not just for school, is something that needs to be addressed and considered, and obviously this discussion has been had with Nphet and the recommendation has been made for implementation." 

Dr Collins said international evidence had shown schools to be a low-risk community setting.

 HSE clinical lead on child health, Dr Abigail Collins. File Picture: Colin Keegan/ Collins Dublin
HSE clinical lead on child health, Dr Abigail Collins. File Picture: Colin Keegan/ Collins Dublin

Asked why it is the case that children who are close contacts of a confirmed case in household and special educations needs settings need to isolate and be tested, but children in primary schools do not, Dr Collins said households still posed the highest risk of transmission.

She said special educational needs settings often had children with medical vulnerabilities and that if a Covid-19 case was notified in such a setting, it would be brought forward for a full public health risk assessment.

"It’s right that those two are considered differently,” she said.

Giving advice to parents, Dr Collins said that if a child had a runny nose, but was otherwise completely well, they do not need to be excluded from school settings.

However, if the child complained of other symptoms, then parents should act accordingly.

"Contact your GP. You are not expected to make that decision about if they should have a Covid-19 test.

"If you have a child you don’t think is well, you observe them and discuss with your primary care physician as per normal."

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