Health

Q&A: Why is contact tracing changing for children when case numbers are going up?

Health editor Paul Cullen explains the Covid policy shift for primary pupils from Monday

Contact tracing is being stopped for asymptomatic cases only. Photograph: iStock

Paul Cullen's face
Paul Cullen Health Editor
Thu Sep 23 2021 - 16:26

I’m confused. Why are they stopping Covid-19 contact tracing in primary schools when case numbers are going up?

You’re not the only one. The move, which takes effect from Monday, has puzzled many parents, who generally favour the change, and teachers, who are more wary.

Routine contact tracing of younger schoolchildren is seen by public health officials as excessive in the context of the current phase of the pandemic, as society seeks to return to (a new) normal. It disrupts the education of those affected by forcing them to stay at home for at least 10 days. It has knock-on effects for other children, and for working parents.

Earlier this month, the HSE quietly ceased routine contact tracing of flights, so the change in policy is not restricted to education.

But aren’t we exposing children to the risk of Covid-19 infection?

We’re talking here about primary-age children only. Routine contact tracing for older children stopped when they started getting vaccinated from 12 years up. Children generally are at very low risk of serious illness from the virus; the risk of being hospitalised is about 1 in 750, for instance. Officials argue the benefit of being able to attend school outweighs the very small risk of serious illness.

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Yet if a lot of children are infected, we will see sizeable numbers requiring treatment, isn’t that the case?

It could be, if the current increase in cases continues unabated. Outbreaks more than doubled last week, and case numbers among children are at their highest level this year. But officials are betting on infections levelling off and even falling pretty soon.

Why? Because this is what happened the previous times we had school re-openings. On each occasion, cases rose transiently and then fell.

Mind you, in contrast to the trend among 5- to 12-year-olds, cases among pre-schoolers are flat at the moment. This seems to point to some form of school-generated effect, even if it proves temporary. We are also starting into this winter from a higher base than last year.

This time, though, nearly everyone else in the population is vaccinated, meaning the potential for onward transmission, outside the classroom, is greatly reduced.

Don’t forget that all the other measures are still in place to mitigate spread - the distancing, the pods, the open windows, etc. This is why officials argue that schools are actually safer for children than in the community in terms of preventing spread of Covid-19. Anyone who has witnessed a crowded playground on a Friday afternoon might be inclined to agree.

There’s an awful lot of testing going on. Doesn’t this show the scale of the problem?

Every day, 1 per cent of 5- to 12-year-olds are being tested. Yet this massive effort is delivering only a modest number of positives. Testing of children has almost quadrupled since schools returned yet incidence has risen by less than 40 per cent. The sniffles and sneezes that might have been neglected over the summer are now being up picked up for testing amid the heightened watchfulness around education. So, officials posit, we’re finding more minor (asymptomatic) cases and the true rise in case numbers is much lower than figures might indicate.

What about long Covid in children?

Any discussion about long Covid is hampered by a lack of consensus over case definition, and the fact we are only learning now about this new condition. There has been a tendency by people on both sides of the argument to cherry-pick figures from studies, so figures for long Covid ranging from 1 per cent to 15 per cent of children have been cited.

Isn’t the UK experiencing a similar rise in school cases?

Yes, but the circumstances are different. Fewer people are vaccinated and many of the other protections used in Irish classrooms are absent in British schools.

I’m still struggling with the idea of letting possible Covid cases go unchecked in the classroom. Doesn’t this go against everything we were told during the pandemic?

Contact tracing is being stopped for asymptomatic cases only. No changes to the rules are being made in special education, because children there could be more vulnerable. Anyone showing symptoms needs to self-isolate and get tested.

In addition, contact tracing is to continue for household contacts of a classroom case, because of the proximity between family members.

According to Prof Philip Nolan of the National Public Health Emergency Team, the probability that an in-school contact becomes infected is low, with attack rates of 2-4 per cent.

Ok, but what are the relevant symptoms for requiring isolation and testing?

This is where things get a bit messy. Over time, the list of symptoms linked to Covid-19 has got longer and longer. The HSE website lists at least 17 of them generally, and 12 for children. Many are similar to the symptoms of cold, flu, hay fever and other respiratory conditions.

There has also been confusion over whether a runny nose is cause for staying at home. The HSE says if it’s just a runny nose, children can attend but if they also feel unwell, they should stay at home.

One school principal has questioned why a child with a head cold could be sent home from school, while a close contact could remain in the classroom.

What about a vaccine for children?

Vaccines are working to stem infections in every other age group, even teenagers, so they seem like a solution for younger children too. But the risks of a vaccine, even if small, could well outweigh the benefits for this age-group. It is also unlikely one will be authorised in Europe this side of Christmas.

It may prove an option for children with heightened health risks but is unlikely to form a wider part of the solution this winter.

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