Clinical trial in secondary school children to replace isolation of close contacts with daily testing

[noblegiraffe]

You might have thought that the government plan to replace isolation for school children with daily LF testing was binned in January when schools had to close. Not so. Apparently they realised that a planned nationwide rollout to children of an intervention when they had no idea if it would increase or decrease transmission rates in schools was not particularly well-supported.

So now they are running a clinical trial. A few schools started this on 15th March and it is being widened to more schools next week. A child who has been identified as a close contact of someone who has tested positive (not within their household as higher risk) will be able to choose 10 days of isolation or 7 days of supervised LF tests at school. Those sitting around them in lessons will not be asked if they are happy with this. Outside of school they will still be expected to isolate because of their increased risk, the testing only allows them to go to school.

Given the general picture of the government's proposals and actions - LF tests now available to all, plans for testing before sports events etc, it's clear that despite serious concerns over their sensitivity (false negatives), they will be forming a large part of future virus control measures. Operation Moonshot.

Expect to see something tested on school children rolled out to workplaces by September.

Details in this twitter thread: twitter.com/karamballes/status/1382838861714296833?s=21

[StarCat2020]

@Cantaloupeisland because schools are magical places where COVID can't spread like everywhere else. We have tape on the floor
"World-beating magical forcefield tape"

[megletthesecond]

little I think I'm happy to keep the 10 day isolation partly because mine haven't had to isolate once yet. Might be famous last words .

[littlepeas]

My perfectly healthy year 7 ds is currently isolating at home despite negative lft because one of his classmates had a positive lft. They will be allowed back to school if the pcr she has taken today comes back negative - keeping everything crossed. He has been physically in school for 4 weeks this year. There are currently 10 cases per 100000 in our local area, I am hoping it was a false positive. It seems like a much better idea to test them daily to me - poor kids have missed enough school.

[megletthesecond]

I've decided to decline the option of potential daily testing for DD. If she has to isolate so be it.

She hates tests and she hates school even more. I simply wouldn't be able to cope with the meltdowns if she was doing them daily to go somewhere she loathes.

[supercatlady]

Rapid tests surely aren’t accurate enough for this?

[Wellbythebloodyhell]

@HedgePutty

Do the LFT magically contain something which stops you developing covid after 7 days?
Like the paying to come out of quarantine early/stopping testing at 5days for the rich?

Presumably they'd revert back to the twice weekly testing they are already currently doing. I suspect those who aren't already doing the twice weekly testing wouldn't opt for the daily testing anyway and choose the isolate option instead or more likely not enforce the isolation and just allow their dc 10 days off school

[noblegiraffe]

Yes, there is the issue that children don't have a choice about whether they go to school and individual consent hasn't been sought about whether they take part in this trial - schools signed up.

It is a very different kettle of fish to a gig that people have opted into (and presumably bought tickets for).

The negative outcome of this trial would be that these children are at an increased risk of catching covid.

[HedgePutty]

Do the LFT magically contain something which stops you developing covid after 7 days?
Like the paying to come out of quarantine early/stopping testing at 5days for the rich?

[HarveySchlumpfenburger]

I think I'd be expecting more than 1 test afterwards too. Maybe one at 3-5 days and one at 10 days. I can't see how they are accurately measuring how this affects spread, if it does. Which makes me wonder what they'll be measuring in schools.

It's a bit like, if we don't look for it, we won't find the answer we don't want. I wonder how far they've got epidemiologists or public health scientists involved in planning these.

[EnoughnowIthink]

It seems sensible to me to trial this. I think moving forward this is the way to go rather than isolating healthy people on the off chance they might develop symptoms

You don't think that we have an obligation to ensure that schools are as covid-safe as they can be for all children? Do you not think there will be unnecessary cases of long-covid and deaths as a result? Or do you think children with vulnerabilities don't deserve the same quality of education as their peers?

[noblegiraffe]

Yes, if they are really interested in testing whether crowds at gigs are safe, wouldn't they use the more accurate tests to pick up cases? Or even better, both, to establish whether LFTs are useful?

[HarveySchlumpfenburger]

www.bbc.co.uk/news/uk-56789454

Slightly linked to this, on the subject of government covid trials. I'd have thought there'd be a bit more active monitoring post this gig rather than just 'give T&T your details' if it's a trial. Especially given some of the studies about the level of compliance with testing when people have symptoms and the 'success' of our T&T system. I'd imagine that's compounded by a bit of selection bias too.

Again a reliance on LFTs rather than a PCR.

Perhaps we can start using government trials in lessons for 'spot the limitations of this trial' in secondary.

[Haydaywithbellson]

It was a primary. Little ones.
I assume they would have infected a few others if no class isolation, especially as they didn't have their own symptoms. It's been a recent change to ask them to get tested at the start of isolation. So with the LFTs half of them might have reported a positive? Or none of them Mad scheme.

[nex18]

It seems sensible to me to trial this. I think moving forward this is the way to go rather than isolating healthy people on the off chance they might develop symptoms. Especially with asymptomatic positives in the first place.

[noblegiraffe]

Is that primary or secondary, Hayday? In most secondary schools the whole class doesn't isolate, just the pupils who have sat immediately around the infected pupil over the course of the day. If those 3 positive pupils were sat around the infected pupil, then in this new scheme they may (and that's not especially confident) be picked up by the LFTs. In the old scheme they would have been sent home to isolate.

In either scheme, if they were in the class but not sat directly around the infected pupil they would have neither taken LFTs nor been sent home to isolate.

[Haydaywithbellson]

When a positive case occurred in dd's school, the whole class isolated - they were also asked to do proper (ie PCR) tests and three more came back positive. None of those positive pupils had any symptoms. Would they have been picked up under this scheme? Or left to sit in class infected another three each perhaps?
I would not send my children to school if this was happening here.

[HarveySchlumpfenburger]

@Iamnotthe1

The accuracy rate for an LFT diagnosing coronavirus in someone who has it has been shown to be poor. In some studies, it's less than 50%. As a close contact, it's the equivalent of flipping a coin and going to school if it's tails.

You can be infectious and it not show up on an LFT. Following this idea logically just suggests that it'll end up with more cases and an increased transmission, particularly when they decide to remove masks from classrooms.

Tbf to the LFTs, they were designed for use in symptomatic cases not asymptomatic ones. The fact that asymptomatic cases may not have a high enough viral load to get a positive result isn't their fault. Nor is the fact that our government are using them for a purpose they weren't intended for.

Using them as an extra line of defence was OK as long as people don't change their behaviour if the result is negative. Using them to replace one of the main non-pharmaceutical interventions is completely idiotic. And I do think there is an issue about the consent of others around you not just the person taking the test.

[EnoughnowIthink]

Very happy with it and a much more rational approach

• on what basis should teachers be expected to be in such close daily contact with people who may have the virus? Is this even reasonably part of their job?
  
• what about vulnerable children? Why don’t they deserve to know who around them may have the virus? Should my vulnerable child be forced to be sitting next to someone for 5 days who then tests positive?

[HazeyJaneII]

I just hope that if they trial this at the dds school, we are able to take them out. Their brother is clinically vulnerable and has shielded all year, it is bad enough having to try and navigate getting back to some sort of 'normal' without him being vaccinated, but sending his sister's into a class where they could be sat next to someone who should be isolating just adds another layer of risk.

[OpheliasCrayon]

@noblegiraffe

I don't think they've conducted a trial to ascertain how accurate LF tests are when administered by children?

Bmj says they're 50/50 when done by kids

[duvetdreaming]

I had a spare LFT so I didn't swab myself at all but processed the test as if I had, expecting a void result. It came back negative.

[noblegiraffe]

They're hoping that repeatedly testing for 7 days will overcome the not so great sensitivity of the tests.

The issue appears to be that no one knows how sensitive the tests are on kids in the first place. If they were very sensitive, this would be a good plan.

I'd love to read the protocol - what's their definition of success in this trial? The guidance linked to in the twitter thread seems to suggest that it will be better than 'whole year group isolations' but in secondary schools whole year group isolations were very rare and the average number of kids isolating per positive case was about 23.

[Iamnotthe1]

The accuracy rate for an LFT diagnosing coronavirus in someone who has it has been shown to be poor. In some studies, it's less than 50%. As a close contact, it's the equivalent of flipping a coin and going to school if it's tails.

You can be infectious and it not show up on an LFT. Following this idea logically just suggests that it'll end up with more cases and an increased transmission, particularly when they decide to remove masks from classrooms.

[Sleepyblueocean]

I'd rather ds do a lft to be allowed out to exercise than to go to school.

[HSHorror]

I would go the other way.
If we keep cases low kids wont need to isolate.
Also presuming 50% get AZ that doesnt work well on SA strain maybe wouldnt want to be in class with them even vaccinated.