The Leeds neuromuscular multidisciplinary team including Dr Anne-Marie Childs, consultant paediatric neurologist, Sue Manning, specialist care advisor and Chris Edwards, respiratory consultant have summarised guidance on back to school in this FAQ document, which has been reviewed and supported by North Star Clinical Network clinicians. 

Back to school guidance, Oct 2020

The government is currently advising that most children should return to school in September, this includes children with neuromuscular conditions.

We understand there maybe anxiety surrounding this decision and we hope the guidance will be helpful.

Many families will have been in isolation or shielding to protect themselves and their families from the Covid19 pandemic.  During this period you will have read, seen, listened to and experienced a great deal regarding this virus.  

Over the summer there has been gradual easing of the lockdown restrictions.  It has become clear, however that the virus is still with us and not likely to disappear soon. There are current local lockdowns and this is likely to continue with local restrictions placed upon those affected areas. This obviously creates a lot of questions and further worry.

The good news is that in a very short period of time we have learnt a lot about this virus and how it affects people. Also there has been a lot written by Public Health England by experts to help control the virus and we hope to answer some questions, and provide some guidance as we enter this next phase.

Please note that the evidence and government guidance does change frequently and may change to respond to local needs as they arise.

All schools have been issued with guidance and are putting plans to put this into effect. However, schools are likely to implement specific and potentially different strategies, depending on the structure, environment and size of school.

It is therefore important to liaise with school staff directly to ensure a plan for your child is in place.

On a personal level:

• If your child has an emergency respiratory, myasthenia or steroid care plan please follow the advice on the plan.
• If your child is unwell please follow the normal pathways you use to access help.

The Public Health England FAQ page provides good general advice and is worth checking for many queries:

https://www.gov.uk/government/publications/coronavirus-outbreak-faqs-what-you-can-and-cant-do

General Questions

1. Is my child more or less risk of developing coronavirus than any other child.

 Children do get coronavirus, but seem to be significantly less affected by it. During the end of the last school year out of a million children at school, less than 70 tested positive for coronavirus (PHE paper Aug23rd). During the peak of the pandemic – March to June 2020 - very small numbers of children, compared to adults, were admitted to hospital and most of these, about 80%, did not require any more than a general ward admission and went home within 72 hours (RCPCH data).   The vast majority of these children had no underlying conditions and world wide very few children have been reported to have had coronavirus.

It is reassuring that having analysed data from global databases, national networks and disease registries, it appears that children and young people with an underlying neuromuscular condition do not have a particularly increased risk of developing a severe Covid 19 infection

There is, however, evidence that the restrictions placed on children during the shielding period have not been without cost to their emotional and physical well-being and therefore it is clear that the balance of risks is now in favour of the majority of children, returning to more normal activities including school.

Is it safe for my child to go to school?

Yes. Although some children do get coronavirus, the evidence suggests that they do not transmit it as much as adults and they are not affected by it as much as adults. Age is the dominant risk factor. Unfortunately this means that teachers are more likely to catch coronavirus and pass it on amongst themselves. Parents and carers will also be at risk at the school gate. Therefore most schools will have put in plans to mitigate this risk such as staggered start and finish times for schools and reduced movement of staff and pupils between classes.   

This means that everyone must continue to follow the general guidance when out of school or going to school:

• Where possible maintain physical distancing of 2 metres
• Face coverings if on public transport, in shops or where a physical distance of 2 metres isn’t possible
• Wash hands frequently and regularly, particularly before eating and touching your face
• If possible, work from home and avoid public transport

Where possible, it would be best to avoid grandparents from collecting children from school as they are more at risk from having severe symptoms if they catch Covid19.

2. How can I protect my child on the way to and from school?

Generally speaking “active transport” such as walking or cycling is recommended, although this may be challenging depending on your child’s exercise tolerance. If your child car shares with another family or uses public transport such as a bus, train or taxi, if they are able, they should wear a mask.

Where the local authority provides school transport then appropriate risk assessments and guidance should be put in place.

Physiotherapy/Personal care

3. Will my child still be able to do their physiotherapy/Physical management programme at school?

We strongly recommend that where a child was doing physiotherapy at school before lockdown this should be continued. The government has issued guidelines to support this (PHE guidance).

 In addition we would recommend for caregivers and teachers to wear a mask if social distancing cannot be adhered to for example during close one to one support. Your child should also wear a mask in these circumstances if he/she is older than 12 years.

When personal care activities are taking place it is good practice for staff to wear gloves, disposal apron, mask and to adhere to stringent hygiene practice.

Masks

4. I thought teachers had been told they weren’t allowed to wear masks?

Currently, teachers in England have been advised not to wear masks when teaching as it inhibits communication. This does not prevent them from wearing masks when in close contact with children if it is felt appropriate.

 In addition we would recommend for caregivers , teachers, and support staff  to wear a mask if social distancing cannot be adhered to  for example during 1:1 support in lessons, help with personal care, hoisting

 Your child should also wear a mask in these circumstances if he/she is older than 12 years.

5. Why are young children advised not to wear masks?

Communication is important at school and seeing the whole face is important for communication.  Outside of schools, the current English guidance is that children under the age of 11 do not need to wear masks, but over the age of 11 they do. The advice is different in different parts of the UK, and WHO offers different advice. Therefore this guidance may change. In smaller preschool children, ie under the age of 5, masks are not recommended as they may cause distress to the child, the children may touch the masks frequently increasing risk of transmission and it maybe a choking risk.

Coughs

6. What do I do if my child gets a new cough or fever?

Isolate, inform the school and organise a Covid swab.

https://www.gov.uk/get-coronavirus-test - click on the green Start Now button half way down the page and put in your child’s name when it asks for your name on the next page. When you have completed the survey it will advise you of the nearest testing centre and available times.

This website tells you what is involved in Covid19 swabbing:

https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

7. My child gets coughs easily do they need to get a Covid swab every time they get a new cough?

Children in general get between 5-15 viral infections a year. Most are seasonal viruses such as RSV or influenza, or the common cold, often caused by rhinovirus. We do not know which cough is caused by Covid19. Covid19 causes particular problems for certain people and we do not want to put them at increased risk. It is therefore important for you and your community that everyone who gets a new cough self isolates and gets a Covid19 swab at this time.

8. What happens if someone in my child’s class or year group bubble is positive for Covid?

Don’t worry. It is very unlikely your child will also have a positive Covid swab. The school will issue advice that will likely involve self-isolating for a period of time. The specific guidance is likely to vary from school to school and overtime as we learn more about how this virus affects schools and children.

Unfortunately this is going to be a very disruptive time to anybody who has children and we hope employers will be sympathetic. It is likely that in large schools these episodes may occur more than once.

Testing, Immunity & Vaccines

9. I had symptoms of Covid19 when testing wasn’t available. Why can’t I be tested for Covid19 antibodies?

Unfortunately Covid19 antibody testing isn’t widely available, although it is increasing. However, we still don’t know enough about the virus to truly know how useful this test is. For example we don’t know if a negative test means that you definitely haven’t had the virus but have undetectable immunity, or if a positive test means you definitely can’t be re infected

10. Why can’t NHS staff/teachers/pupils have regular swab tests so my child is protected?

The swab only tells us if the staff member has Covid19 at that particular time point. Currently the swab test takes on average about 24 hours to come back. So for this to work the staff member would have to isolate form the point the swab is taken until they finish their run of shifts. This is impractical. Also the test may be falsely negative or positive in a small percentage of cases, providing false reassurance.

11. Why is it taking so long to develop a vaccine when we have a new influenza vaccine every year?

The influenza vaccine is “tweaked” slightly every year depending on the strain of ‘flu that is around that season and so does not need new development or new extensive testing.

12. How come they are able to develop a new vaccine for Covid19 so quickly? Will it be safe? Why can’t we have the Russian vaccine?

Immunisation development has advanced over the years. We now have new technology that enables us to know the genetic code and structure of this virus, which then allows us to make best guess approaches at which bits of the virus we need to use to produce the best immune response. We have developed different ways of carrying these bits into the body to produce the best response and we can test them out in the labs in new ways before doing animal trials. We can take lessons from previous coronavirus outbreaks (SARS1 and MERS) when vaccine development started that will apply to Covid19. As we know these methods to be effective and safe, it has allowed quick development of multiple trial vaccines that have then passed into safety trials. Unfortunately phase 2 and 3 trials will take longer and involve lots of people before the vaccine can be ensured to be safe for the general population. So it is unlikely there will be a vaccine available in the UK until next year. Scientists in the UK worry about the safety and efficacy of the Russian and other vaccines as they have been developed so quickly.

Other

13. What about this inflammatory disease?

We still don’t know much about this other than it seems to be a rare syndrome that may be a delayed reaction to having had Coronavirus. It has only affected a small number of children and not all of them have required treatment. There appears to be no specific risk factors, but the treatment (steroids, and if required, immunoglobulins) appears to be effective.

14. Are there any treatments we can take if we think we have Covid19?

No. Like most viruses, Covid19 is managed mainly with supportive therapies: maintaining good fluid intake and antipyretics like paracetamol. The evidence so far for antivirals and hydroxychloroquine has been disappointing. Dexamethasone, a steroid, has been shown to reduce the time people need admission to hospital, but only in those who were unwell enough to need oxygen. It didn’t make a significant difference to those who didn’t need to be admitted.

15. What else can I do to protect my child and my family as lockdown eases?

The general advice stands for everyone:

• Where possible maintain physical distancing of 2 metres
• Face coverings if on public transport, in shops or where a physical distance of 2 metres isn’t possible
• Frequent regular washing of hands
• If possible, work from home and avoid public transport
• Take a vitamin D supplement if you are not already on one.
• Maintain a healthy diet, do regular exercise and get an adequate amount of sleep.
• Use online delivery shopping

Some schools are recommending that children wear freshly washed uniform each day. If this is the case then wash the clothes on the highest temperature the clothing recommends.

If you work in a people facing role, if possible wash and change your work clothes either at work or before you collect your child from school. As a minimum, clean your hands as you leave work.  

We hope this advice is useful. You can download this as a pdf here.

 https://www.gov.uk/government/publications/coronavirus-outbreak-faqs-what-you-can-and-cant-do