Prevention and control measures
While the vaccination programme was being rolled out, non-pharmaceutical interventions (NPI) such as physical distancing, hand and respiratory hygiene, face coverings, ventilation, testing and zero-tolerance to symptoms were the main public health tools against COVID-19. Staff and pupil safety and wellbeing is enhanced by the application of appropriate mitigations within the school environment, commensurate with the level of risk in that environment.
The virus spreads mainly between people who are in close contact with each other. Infection can occur when aerosols or droplets containing the virus are breathed in or come into contact with the eyes, nose, or mouth. Transmission risk is increased in indoor places that are poorly ventilated or crowded, and where people tend to spend longer periods of time, because aerosols remain suspended in the air. There is increasing evidence of airborne transmission over longer distances in some situations.
Looking forward, we expect that the role of NPIs in managing the epidemic in Scotland will be reduced as the protective effect of the vaccine both reduces the direct health harms of the virus and helps to reduce transmission. However, there will need to be some baseline mitigations in order to stop the virus resurging and to protect those who do not have protection from vaccination. Behavioural responses and good risk assessment will remain crucial.
The updated coronavirus (COVID-19): guidance on reducing the risks in schools has been developed to support a safe return to school for all children, young people and staff in August 2021.
Separate guidance is in place for ELC and childcare settings, providing a package of age-appropriate public health measures.
Letting fresh air into indoor spaces can help remove air that contains virus particles and thereby help prevent the spread of COVID-19. In poorly ventilated rooms the amount of virus in the air can build up, increasing the risk of spreading COVID-19.
The Environmental Modelling Group (EMG) has previously given guidance on the importance of ventilation to mitigate transmission of COVID-19 including recommending appropriate ventilation rates and providing baseline on carbon dioxide (CO2) concentrations in indoor air that indicate good or poor ventilation. It has since published an updated paper considering in more detail the application of CO2 monitoring as an approach to managing ventilation to mitigate transmission of COVID-19 . It states:
“CO2 monitoring can be a cost-effective way of helping to identify spaces with high occupancy and/or poor ventilation and for actively managing ventilation in a space. It can be used to enable a good balance between ventilation, thermal comfort, and energy use.”
Evidence grows that face coverings are effective in reducing the transmission of coronavirus and the World Health Organisation recommends their use in the community and in certain workplaces. The current World Health Organisation (WHO) checklist promotes the wearing of face coverings among students (by age) teachers and school staff, and especially where physical distancing cannot be achieved. It states:
“Students should be educated on the proper use of masks and the disposal of masks after use. Note that teachers and school staff may be required to wear masks if they cannot guarantee the 1 metre distance or if they are in areas experiencing established community transmission.”
The EMG says that transmission is strongly associated with proximity, duration and frequency of contact, and with community prevalence. The highest risks of transmission are associated with poorly ventilated and crowded indoor settings. The Scientific Advisory Group for Emergencies (SAGE) and the EMG report a significant reduction in exposure to all virus-containing droplets where around 2 metres of distance is maintained.
While it is not possible to isolate the effects of physical distancing restrictions from other control measures, there is consistent evidence of negative societal impacts over the course of the pandemic. This includes a large reduction in social connectivity, and higher levels of loneliness and anxiety, particularly for younger people. The lockdown lowdown survey of young people in Scotland described the impact that COVID-19 had had on their relationships, including a reduced quality of friendships and psychological literature shows that children rely on social interaction with their peers to meet their broad developmental needs including learning, well-being and positive mental health outcomes.
Regular testing using lateral flow devices (LFDs), also known as rapid tests, helps to find positive cases in people who have no symptoms, but who are still infectious. Evaluations from Public Health England and the University of Oxford show LFD tests are accurate and sensitive enough for specific case uses within the community setting (such as schools).
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