Self-isolation and testing
Ongoing communication is needed to ensure that everyone remains alert to the core symptoms of COVID-19 i.e. loss/change of taste/smell, fever or persistent dry cough, and aware that they should not go to a school or ELC setting if they have even mild symptoms, unless they have a negative PCR test. The need for ongoing support for people who do have to self-isolate will remain, even if the numbers reduce as a result of a change to the policy.
If Scotland moves beyond level 0 on 9 August, there will be a change in the self-isolation requirements for fully vaccinated close contacts of people who test positive for COVID-19. This will mean that fully vaccinated close contacts will only be required to isolate until they receive a negative PCR test.
Given the lower likelihood of children to experience direct COVID-related health harms, self-isolation of children and young people as close contacts is primarily for the benefit of other age-groups who are more likely to experience adverse health effects from the virus. As the vaccination programme impacts on the rate of positive COVID-19 cases among the adult population and the link between positive cases and hospitalisation reduces, the current approach to self-isolation should be reconsidered for under 18s as for the general population.
Any decision to exempt, or modify, isolation guidance for children and young people will carry some potential risks to people in contact with those young people, and through community transmission of COVID-19. These risks should be balanced against the harms caused to children, young people and their families of repeated instances of isolation including:
- disruption to children’s education, learning and development, in addition to the disruption caused by previous lockdowns
- the negative mental health impact of being isolated from peers
- the disruption to family life and employment, including the impact on families of having to provide childcare and potentially take leave from work on repeated occasions
- the additional impact on some groups of children and young people living in less stable households where parents or guardians are less likely to be able to support them with education or emotionally
Taking all of the above into account, the sub-group considers that the current position on self-isolation for children and young people as contacts is not commensurate with the risk going forward and should be revised to exempt all children and young people from isolation as close contacts unless they are symptomatic or have a positive test.
Children or young people who are contacts of someone with COVID-19 (whether in a school/ELC setting or elsewhere) but who have not tested positive themselves, would not be required to isolate unless they develop one of the core symptoms as set out in the NHS guidance. School-aged close contacts should be advised to book a PCR test as soon as possible, and only end self-isolation and return to school if/when they receive a negative PCR test result. This would see a large reduction in the number of children and young people required to self-isolate, with only positive cases and people with symptoms being required to be absent from school until such time as they receive a negative result from a PCR test (provided they are well enough, and have not had a fever for 48 hours – in line with current guidance). It would also significantly relieve pressure on ELC and school staff who currently have to identify contacts and liaise with local IMTs, and also on those IMTs who undertake a lot of contact tracing activity with children and young people.
Schools and ELC settings could send out a general alert when there is a case in the setting, to ask parents to be extra vigilant and look out for symptoms (warn and inform approach) and highlight that children with symptoms should self-isolate and get a PCR test.
In order to ensure that schools re-open safely, the sub-group recommends that staff in all education and local authority ELC settings, and secondary pupils be asked to undertake an LFD home test no more than two days before they return to school in August. The sub-group notes that this is in line with advice provided to schools and local authorities prior to the summer break.
Given that a change in approach to self-isolation requires assessment of a range of factors, the sub-group strongly advises a precautionary, staged approach in order to monitor the impacts, and to allow the system the flexibility to respond to data and developments. The sub-group has identified three possible options for the timing of the recommended change, each of which requires a decision based on the relative balance of COVID related health risks, with the wider health and educational harms, and with deliverability constraints. The options are:
Remove the requirement for self-isolation of close contacts for all children and young people aged 0-17 when the schools return from the week beginning 9 August, aligning with the anticipated move beyond Level 0 for wider society.
This approach would:
- bring schools and ELC settings in line with the requirements for wider society in that the change would occur at the same time as the requirement is removed for self-isolation of adults who have been double-vaccinated
- reflect the fact that children and young people transmit the virus at lower rates than (unvaccinated) adults and, as such, present a lower risk to each other, household members, family, and to staff
- avoid any potential confusion that could arise if self-isolation policy were differentiated according to age amongst older and younger children
- be relatively straightforward to communicate and implement, thereby enhancing adherence
Remove the requirement for self-isolation in the youngest age groups (ELC and primary aged pupils plus S1 to assist with transition) when schools return from the week beginning 9 August, but delay the exemption of secondary-aged pupils from self-isolation as close contacts until a minimum of 6 weeks following the start of term to the point when all adults should be fully vaccinated, thereby aligning with the well-understood message that full vaccination is a critical protective measure.
This approach would:
- bring the position for younger children in line with the general population, but leave secondary school pupils subject to a different approach for a period of several weeks, placing them under greater restriction than the rest of society and at a critical time for the re-establishment of a stable educational experience
- reduce the potential risk to secondary school staff who have not been fully vaccinated at the start of the school term, bearing in mind that those staff are likely to be in the younger age groups for whom the clinical risks of the disease are relatively low and the effectiveness of Pfizer and Moderna vaccines are relatively high even after a single dose
- exacerbate, for secondary pupils, any impacts of living in less stable households during the pandemic, and during the summer break, through impacting on the support and stability that school attendance provides
- bring logistical and messaging challenges, due in part to differentiation according to school-year rather than age
Remove the requirement for self-isolation of close contacts for all children and young people aged 0-17 a minimum of 6 weeks following the start of term when all adults should be fully vaccinated, thereby aligning with the well-understood message that full vaccination is a critical protective measure.
This approach would:
- reduce any potential risk to school and ELC staff who have not been fully vaccinated at the start of the school term, bearing in mind that those staff are likely to be in the younger age groups for whom the clinical risks of the disease are relatively low
- reduce any potential adverse health impacts from COVID among children and young people
- result in ongoing school absences for many children and young people who are not ill, but who will experience continued educational disruption due to isolation as contacts; this disruption will be experienced unequally and will potentially increase health and educational inequalities
- be more straightforward than option 2 in terms of logistics, but would be out of step with the approach being taken in wider society, and impose more stringent requirements on all children and young people than the rest of the population
Based on the relative balance of COVID-19 infection, transmission and harms among children and young people, with the significant and sustained educational and wider health harms that result from the current self-isolation policy, the sub- group recommends that Option 1 should be taken forward in guidance. However, if this option is implemented, it should be accompanied by the retention of a package of other mitigations, including an enhanced approach to testing, as well as clear and consistent communication to ensure that everyone remains alert to the core symptoms of COVID-19.